The laboratory epidemiological study of the joint circulation of the influenza virus A subtypes A/H1N1/ and A/H3N2/ in Bulgaria]

The National Influenza Center of Bulgaria made the epidemiological analysis of the spread of influenza virus, type A, for the period of 11 years on the basis of mass laboratory investigations. Subtype A (H1N1) was found to be the main factor of epidemics in 1978 and 1982, while the epidemics of 1980, 1983, 1985, 1986, 1987 and 1988 were mainly caused by subtype A (H3N2). The data of laboratory and epidemiological studies indicated that after 20-year absence influenza virus A, subtype A (H1N1), was found again to circulate among the population of Bulgaria, and in 1978-1988 circulated simultaneously with the previous subtype A (H3N2). The simultaneous circulation of two subtypes of influenza virus was of great importance for the frequency, spread and duration of influenza epidemics.     

Molecular characterization and phylogenetic analysis of enteroviruses inducing the outbreaks and seasonal rises of morbidity in different regions of the Republic of Belarus

As shown by the results of the analysis, viruses ECHO 30 circulating over the period of the last 8 years in Belarus, belonged to 3 different genetic subtypes which earlier or simultaneously circulated in other European states. The outbreaks of enterovirus infections (EVI) were facilitated by the appearance of a genetic viral subtype, relatively "new" for human population, and which had not earlier circulated on this territory. Thus, the development of outbreak morbidity in 2003 was caused by a change in the dominating subtype of virus ECHO 30, which caused the outbreak of 1997. The relatively "soft" rise of morbidity in 2004 was due to the continued circulation of the same subtype of virus ECHO 30, that in 2003. The largest outbreaks of EVI in the Republic of Belarus had a number of considerable differences: the outbreak of 1997 in Gomel was characterized by the genetic heterogeneity of infective agents, being simultaneously geographically localized within the limits of one city. However, during the outbreaks of 2003 the circulation of genetically closely related viruses of the one subtype among the population of geographically remote regions of the country was registered.     

Surveillance for Seasonal Influenza Virus Prevalence in Hospitalized Children with Lower Respiratory Tract Infection in Guangzhou,China during the Post-Pandemic Era

Background

Influenza A(H1N1)pdm09, A(H3N2) and B viruses have co-circulated in the human population since the swine-origin human H1N1 pandemic in 2009. While infections of these subtypes generally cause mild illnesses, lower respiratory tract infection (LRTI) occurs in a portion of children and required hospitalization. The aim of our study was to estimate the prevalence of these three subtypes and compare the clinical manifestations in hospitalized children with LRTI in Guangzhou, China during the post-pandemic period.

Methods

Children hospitalized with LRTI from January 2010 to December 2012 were tested for influenza A/B virus infection from their throat swab specimens using real-time PCR and the clinical features of the positive cases were analyzed.

Results

Of 3637 hospitalized children, 216 (5.9%) were identified as influenza A or B positive. Infection of influenza virus peaked around March in Guangzhou each year from 2010 to 2012, and there were distinct epidemics of each subtype. Influenza A(H3N2) infection was more frequently detected than A(H1N1)pdm09 and B, overall. The mean age of children with influenza A virus (H1N1/H3N2) infection was younger than those with influenza B (34.4 months/32.5 months versus 45 months old; p<0.005). Co-infections of influenza A/ B with mycoplasma pneumoniae were found in 44/216 (20.3%) children.

Conclusions

This study contributes the understanding to the prevalence of seasonal influenza viruses in hospitalized children with LRTI in Guangzhou, China during the post pandemic period. High rate of mycoplasma pneumoniae co-infection with influenza viruses might contribute to severe disease in the hospitalized children.     

Surveys of Respiratory Virus Antibodies in an Arctic Indian Population

A study was undertaken to determine the etiological agents responsible for epidemics in a small and relatively isolated Arctic community.Three serological surveys were carried out over a four-year period employing complement fixation tests. Clinical information from the resident nurse was also available.The results indicated that of the two clinical epidemics of “influenza” which occurred during the period of study one was due to influenza virus type A; the other was unidentified. However, influenza virus type B affected approximately 30% of the population at some time during a two-year period without being clinically recognized. An epidemic affecting mainly children, which was clinically considered to be whooping cough, was probably caused by an adenovirus. A mumps epidemic with a high attack rate for all age groups which had occurred a few months prior to the first survey was confirmed. Sendai virus and psittacosis virus are probably endemic in this community.     

Effectiveness of the 2012/13 Trivalent Live and Inactivated Influenza Vaccines in Children and Adolescents in Saxony-Anhalt,Germany: A Test-Negative Case-Control Study

A live attenuated influenza vaccine has been available in Germany since the influenza season 2012/13, which is approved for children aged 2-17 years. Using data from our laboratory-based surveillance system, we described the circulation of influenza and non-influenza respiratory viruses during the influenza season 2012/13 in Saxony-Anhalt. We estimated the effectiveness of live and inactivated trivalent influenza vaccines in preventing laboratory-confirmed cases among children and adolescents. From week 40/2012 to 19/2013, sentinel paediatricians systematically swabbed acute respiratory illness patients for testing of influenza and 5 non-influenza viruses by PCR. We compared influenza cases and influenza-negative controls. Among children aged 2-17 years, we calculated overall and vaccine type-specific effectiveness against laboratory-confirmed influenza, stratified by age group (2-6; 7-17 years). We used multivariable logistic regression to adjust estimates for age group, sex and month of illness. Out of 1,307 specimens, 647 (35%) were positive for influenza viruses and 189 (15%) for at least one of the tested non-influenza viruses. For vaccine effectiveness estimation, we included 834 patients (mean age 7.3 years, 53% males) in our analysis. Of 347 (42%) influenza-positive specimens, 61 (18%) were positive for A(H1N1)pdm09, 112 (32%) for A(H3N2) and 174 (50%) for influenza B virus. The adjusted overall vaccine effectiveness including both age groups was 38% (95% CI: 0.8-61%). The adjusted effectiveness for inactivated vaccines was 37% (95% CI: -35-70%) and for live vaccines 84% (95% CI: 45-95%). Effectiveness for the live vaccine was higher in 2-6 year-old children (90%, 95% CI: 20-99%) than in children aged 7-17 years (74%, 95% CI: -32-95%). Our study of the strong influenza season in 2012/13 suggests a high preventive effect of live attenuated influenza vaccine especially among young children, which could not be reached by inactivated vaccines. We recommend the use of live attenuated influenza vaccines in children unless there are contraindications.     

503例儿童急性呼吸道感染常见病毒的检测结果分析

目的通过对503例急性呼吸道感染患儿进行7种常见病毒[流感病毒A、B型（IVA、IVB）,腺病毒（ADV）,副流感病毒1、2、3型（PIV1、PIV2、PIV3）及呼吸道合胞病毒（RSV）]的检测,了解本地区2013年急性呼吸道感染患儿的病毒感染状况。方法应用免疫荧光法对503例急性呼吸道感染患儿的咽拭子进行7种常见病毒的检测。结果 503例患儿中有55例检出病毒阳性,总阳性率为10.93%,均为单一病毒感染。7种常见病毒中,RSV的感染率最高,为76.36%。在各年龄组中,〈1岁组的病毒检出率最高,为29.41%,随着年龄的增长,检出率逐渐降低。从季节分布来看,春季的感染率最高,为23.08%,其次为冬季,感染率10.13%。结论 RSV是2013年本地区儿童急性呼吸道感染的主要病毒,〈1岁组患儿的病毒检出率最高,春季为感染的高发季节。     

Influenza Virus Surveillance in Pakistan during 2008-2011

Background

There is little information about influenza among the Pakistani population. In order to assess the trends of Influenza-like-Illness (ILI) and to monitor the predominant circulating strains of influenza viruses, a country-wide lab-based surveillance system for ILI and Severe Acute Respiratory Illness (SARI) with weekly sampling and reporting was established in 2008. This system was necessary for early detection of emerging novel influenza subtypes and timely response for influenza prevention and control.

Methods

Five sentinel sites at tertiary care hospitals across Pakistan collected epidemiological data and respiratory samples from Influenza-like illness (ILI) and severe acute respiratory illness (SARI) cases from January 2008 to December 2011. Samples were typed and sub-typed by Real-Time RT-PCR assay.

Results

A total of 6258 specimens were analyzed; influenza virus was detected in 1489 (24%) samples, including 1066 (72%) Influenza type A and 423 (28%) influenza type B viruses. Amongst influenza A viruses, 25 (2%) were seasonal A/H1N1, 169 (16%) were A/H3N2 and 872 (82 %) were A(H1N1)pdm09. Influenza B virus circulation was detected throughout the year along with few cases of seasonal A/H1N1 virus during late winter and spring. Influenza A/H3N2 virus circulation was mainly observed during summer months (August-October).

Conclusions

The findings of this study emphasize the need for continuous and comprehensive influenza surveillance. Prospective data from multiple years is needed to predict seasonal trends for vaccine development and to further fortify pandemic preparedness.     

Circulation of respiratory viruses in Moscow and their role in acute respiratory diseases morbidity

Statistical data obtained during prolonged investigations on the structure of infective agents isolated from patients with acute respiratory diseases (ARD) in Moscow in 1989-1999 were analyzed. The study revealed that fluctuations of ARD morbidity rates were linked with the prevailing circulation of one or another type of the virus. The absence of the dominating role of influenza viruses was confirmed. The conclusion was made on the necessity of using, in addition to influenza vaccinal prophylaxis, chemoprophylactic interventions to maintain ARD morbidity on the acceptable level.     

Incidence of avian flu worldwide and in the Russian Federation. Improvement of surveillance and control of influenza during preparation for potential pandemic

Problem of influenza and acute respiratory virus infections (ARVI) remains one of the most urgent medical and socio-economic issues in despite of certain achievements in vaccine and chemoprophylaxis. In Russia influenza and ARVI account for up to 90% of the total annual incidence of infectious disease (up to 30 million of sick people; 45-60% of them are children). Economic damage, caused by influenza and ARVI, makes around 86% of total economic damage, caused by infectious diseases. WHO predicts that in the years coming a new antigenic influenza virus will appear, which can lead to development of large pandemia with 4-5 times increase in disease incidence and 5-10 times increase in death rate. During 2005 some changes in animal influenza epidemiology were registered. New cases of people infections are detected, the virus has spread to some new countries. Avian influenza is a high contagious virus infection that can affect all bird species. For birds influenza is enteral infection, it severely affects parenchymatous organs, especially spleen, and lungs. By now it is known that carriers of avian influenza virus H5N1 can be all known species of wild waterfowl and near-water birds. Poultry is highly susceptible to many stocks of influenza virus H5N1, death rate reaches 100%. At that hens, especially chickens, are most susceptible. From January 2004 to 24th November 2005 in the world there were detected 131 cases of influenza, caused by virus A/H5N1/, 68 of them (51%) ended in lethal outcome (Vietnam--92 cases, Thailand--21 cases, Cambodia--4, Indonesia--11, China--3). Most of the described cases of avian influenza resulted from direct contact with infected birds (handling bird internal organs is especially dangerous). In frozen meat of infected birds the virus can remain for about one year. Heating kills virus (no cases of infection caused by use for food of poultry products were detected). In order to prevent wide ranging spread of infection over Russia it is necessary to organize medical monitoring of sea ships, aircraft and train crews, arriving from the countries where influenza H5N1 cases were detected, in case of need to arrange raids to outlets and markets to detect poultry and poultry products brought from these countries. In Russia it is necessary to prepare a reserve of vaccine strains of viruses--potential causative agent of pandemic, including H5N1 and H7N7, that can start to vaccine reproduction immediately in case of pandemic.     

The role of respiratory tract viruses in the etiology of obstructive bronchitis in infants

Out of 524 children with acute respiratory infections in 141 obstructive bronchitis was diagnosed (OZO). Seventy cases could be linked to viral infection. Viral infections tested (influenza virus A, B, parainfluenza typ 1-3, RSV, adenoviruses) were more frequently associated with OZO than other acute respiratory infections of unknown etiology. Majority infections induced by influenza virus A and parainfluenza virus typ 2 were accompanied by OZO symptoms. Of the highest risk of acquiring OZO despite of viral infection participation, were children of 4-12 months of age. OZO associated viral infections prevailed during autumn-winter season, while in spring-summer period undetermined factors were the major cause of OZO. In serum samples of children with OZO, despite of etiology of the disease, higher level of IgE was found than in a group of children without the symptoms. In the case of OZO of unestablished etiology the level of serum IgE was significantly higher than in the cases when viral etiology of the disease was found.     

Expanded Cocirculation of Stable Subtypes,Emerging Lineages,and New Sporadic Reassortants of Porcine Influenza Viruses in Swine Populations in Northwest Germany

The emergence of the human 2009 pandemic H1N1 (H1N1pdm) virus from swine populations refocused public and scientific attention on swine as an important source of influenza A viruses bearing zoonotic potential. Widespread and year-round circulation of at least four stable lineages of porcine influenza viruses between 2009 and 2012 in a region of Germany with a high-density swine population is documented here. European avian influenza virus-derived H1N1 (H1N1av) viruses dominated the epidemiology, followed by human-derived subtypes H1N2 and H3N2. H1N1pdm viruses and, in particular, recently emerging reassortants between H1N1pdm and porcine HxN2 viruses (H1pdmN2) were detected in about 8% of cases. Further reassortants between these main lineages were diagnosed sporadically. Ongoing diversification both at the phylogenetic and at the antigenic level was evident for the H1N1av lineage and for some of its reassortants. The H1avN2 reassortant R1931/11 displayed conspicuously distinct genetic and antigenic features and was easily transmitted from pig to pig in an experimental infection. Continuing diverging evolution was also observed in the H1pdmN2 lineage. These viruses carry seven genome segments of the H1N1pdm virus, including a hemagglutinin gene that encodes a markedly antigenically altered protein. The zoonotic potential of this lineage remains to be determined. The results highlight the relevance of surveillance and control of porcine influenza virus infections. This is important for the health status of swine herds. In addition, a more exhaustive tracing of the formation, transmission, and spread of new reassortant influenza A viruses with unknown zoonotic potential is urgently required.     

The immunomodulating action of the surface antigens of the influenza A virus in experimental staphylococcal infection

The results of the study of influenza A virus surface antigens, hemagglutinin and neuraminidase, in the induction of nonspecific immunomodulation and protection from acute pulmonary staphylococcal infection have been studied. Protective effect, the cell composition of bronchoalveolar lavage fluid depend on the serological subtypes of surface antigens used for intranasal immunization and the infective dose of staphylococci.     

Fatal cases of influenza A(H3N2) in children: insights from whole genome sequence analysis

During the Northern Hemisphere winter of 2003-2004 the emergence of a novel influenza antigenic variant, A/Fujian/411/2002-like(H3N2), was associated with an unusually high number of fatalities in children. Seventeen fatal cases in the UK were laboratory confirmed for Fujian/411-like viruses. To look for phylogenetic patterns and genetic markers that might be associated with increased virulence, sequencing and phylogenetic analysis of the whole genomes of 63 viruses isolated from fatal cases and non fatal "control" cases was undertaken. The analysis revealed the circulation of two main genetic groups, I and II, both of which contained viruses from fatal cases. No associated amino acid substitutions could be linked with an exclusive or higher occurrence in fatal cases. The Fujian/411-like viruses in genetic groups I and II completely displaced other A(H3N2) viruses, but they disappeared after 2004. This study shows that two A(H3N2) virus genotypes circulated exclusively during the winter of 2003-2004 in the UK and caused an unusually high number of deaths in children. Host factors related to immune state and differences in genetic background between patients may also play important roles in determining the outcome of an influenza infection.     

Significance of persons with different blood groups in the influenza type A epidemic process

To study the susceptibility of persons with different blood groups to influenza A, the presence of infection in a group of young children placed under constant observation for 6 years (1974-1980) and in a group of donors observed during 1979-1980 was studied in different epidemic situations. The susceptibility of the persons under observation to type A influenza viruses was shown to depend both on the blood group of the subjects and on the properties of circulating viruses. Persons with group B (III) blood were more susceptible to the virus at the period when new antigenic variants and serotypes appeared, persons with group O (I) blood were more susceptible to influenza infection at the period of the circulation of virulent strains, while persons with group A (II) blood were more susceptible at the period when less virulent strains circulated. The susceptibility of persons with different blood groups was found to change as changes in the properties of the strains occurred in the process of their circulation.     

Crimean-Congo hemorrhagic fever in Rostov Province: the epidemiological characteristics of an outbreak

The results of the epidemiological analysis of the outbreak of hemorrhagic fever which was caused by Crimean-Congo hemorrhagic fever virus and occurred during the period of July 3-19, 1999, in the Oblivskaya district of Rostov Province are presented. The specific epidemiological features of the outbreak have been determined. The possible versions of the appearance of the focus of infection and the role of Ixodes ticks in the circulation of the infective agent are discussed.     

Population-Based Hospitalization Burden of Influenza A Virus Subtypes and Antigenic Drift Variants in Children in Hong Kong (2004–2011)

Objectives

We aim to document and analyze influenza hospitalization burden in light of antigenic changes in circulating influenza viruses in Hong Kong.

Methods

The pediatric age-specific rates of influenza A hospitalization in Hong Kong for 2004–2011 which encompassed the emergence of H1N1pdm09 were extrapolated from admissions to 2 hospitals that together catered for 72.5% of all pediatric admissions on Hong Kong Island. Influenza A was detected by immunofluorescence, culture and/or PCR on nasopharyngeal aspirates.

Results

Influenza A caused high rates of hospitalization in children with year to year fluctuations. The highest hospitalization burden was seen with H1N1pdm09 in 2009. Additional factors affecting hospitalization were the proportion of viral circulation among different subtypes, and antigenic drifts. Taking these into effect, an H3N2 dominated year was not always associated with more hospitalizations than a ‘seasonal’ H1N1 year. Hospitalization burden was higher in seasons when drifted viruses of H1N1 or H3N2 dominated. No hospitalization was documented in infants <6 months of age during years when an undrifted virus circulated (2006 for H1N1 and 2008 for H3N2) but significant hospitalization was observed with a drifted or shifted virus (2004, 2005, 2007 and 2010 for H3N2, and 2009 for H1N1pdm09).

Conclusions

We documented a consistently high pediatric hospitalization burden of influenza A. Knowledge of antigenic changes and their proportion of circulation aids in the interpretation of impact of the subtypes. Year-to-year variation in hospitalization rates in young infants appeared to correlate with antigenic variation, lending support to the role of protection from maternal antibodies.     

Significance of the heterogeneity of respiratory syncytial viral populations in the development of the epidemic process

The manifestations of the epidemic process in respiratory syncytial (RS) virus infection induced by the strains of the infective agent, differing in their capacity for reproduction at 39 degrees and 37 degrees C and in their sensitivity to antibodies, were compared. The observation of children in a group (about 80 children simultaneously) with the systematic serological and virological examination of sick and healthy children was the main method in this investigation. The circulation of RS viruses with greater capacity for reproduction at 39 degrees and 37 degrees C and lesser sensitivity to antibodies, i.e. viruses with greater virulence, was accompanied by the increased intensity of manifestations of the epidemic process. An increase in the heterogeneity of RS virus populations isolated at the same period of observation was accompanied by the intensification of the epidemic process, which was manifested by increased morbidity rate and a higher level of contamination in children, an increase in the incidence of outbreaks and in the frequency of RS virus reinfection.     

Clinical Characteristics Are Similar across Type A and B Influenza Virus Infections

Background

Studies that aimed at comparing the clinical presentation of influenza patients across virus types and subtypes/lineages found divergent results, but this was never investigated using data collected over several years in a countrywide, primary care practitioners-based influenza surveillance system.

Methods

The IBVD (Influenza B in Vircases Database) study collected information on signs and symptoms at disease onset from laboratory-confirmed influenza patients of any age who consulted a sentinel practitioner in France. We compared the clinical presentation of influenza patients across age groups (0–4, 5–14, 15–64 and 65+ years), virus types (A, B) and subtypes/lineages (A(H3N2), pandemic A(H1N1), B Victoria, B Yamagata).

Results

Overall, 14,423 influenza cases (23.9% of which were influenza B) were included between 2003–2004 and 2012–2013. Influenza A and B accounted for over 50% of total influenza cases during eight and two seasons, respectively. There were minor differences in the distribution of signs and symptoms across influenza virus types and subtypes/lineages. Compared to patients aged 0–4 years, those aged 5–14 years were more likely to have been infected with type B viruses (OR 2.15, 95% CI 1.87–2.47) while those aged 15–64 years were less likely (OR 0.83, 95% CI 0.73–0.96). Males and influenza patients diagnosed during the epidemic period were less likely to be infected with type B viruses.

Conclusions

Despite differences in age distribution, the clinical illness produced by the different influenza virus types and subtypes is indistinguishable among patients that consult a general practitioner for acute respiratory infections.     

2012-2015年广东省活禽市场外环境禽流感病毒污染状况研究

研究广东省活禽市场外环境禽流感病毒污染状况并及时发现人流感发病潜在的危险因素,为人流感防治提供科学参考依据。应用传染病技术监测平台信息管理系统数据,采用描述性流行病学方法分析各种亚型病毒感染的流行病学特征,研究2012-2015年广东省活禽市场外环境禽流感病毒污染。共采集检测广东省21个地市级样本33079份,FluA 总阳性率为24．23％,H5、H7和 H9型高致病性禽流感病毒阳性率分别为3．70％、3．89％和13．53％;除2012年阳性率呈现季节性增加外,其他年份 FluA 核酸检测阳性率均在冬春季出现一个高峰。不同部位或地点采集的标本中,宰杀或摆放禽肉案板表面阳性率最高（FluA39．49％,H58．41％,H77．41％,H923．84％）,而采集的粪便标本阳性率最低（FluA14．99％,H51．73％、H72．38％、和 H97．23％）;所采集的标本所对应的相关动物种类中,鸡（64．08％）、鸭（55．84％）和鸟类（51．92％）的禽流感病毒阳性率都达到50％以上,H5、H7和 H9在各禽类中均可以检出。同时发现,在环境中检出 H7亚型多的地区分布与其相应地区 H7N9感染的病例数呈显著相关性,（r ＝0．689,P ＜0．05）;对2322份样本进行 H6亚型核酸检测,总阳性率为2．58％,并选取 H5、H6和 H9亚型标本153份进行 N 亚型检测,检测出 H5N1、H5N2、H5N6、H6N2和 H9N2等多种亚型。2012-2015年广东省21个地市活禽市场均存在 HA 亚型（H5、H7、H9和 H6）和 NA 亚型（N1、N2、N6）等多种亚型的污染,污染程度呈现季节性分布,不同样本类型和禽类其禽流感病毒分状况不同,H7亚型的污染严重程度与 H7N9的病例感染数呈正相关性。