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1

Phylogenetic evolution of swine-origin human influenza virus: a pandemic H1N1 2009.  

Science.gov (United States)

The knowledge of the genome constellation in pandemic influenza A virus H1N1 2009 from different countries and different hosts is valuable for monitoring and understanding of the evolution and migration of these strains. The complete genome sequences of selected worldwide distributed influenza A viruses are publicly available and there have been few longitudinal genome studies of human, avian and swine influenza A viruses. All possible to download SIV sequences of influenza A viruses available at GISAID Platform (Global Initiative on Sharing Avian Influenza Data) were analyzed firstly through the web servers of the Influenza Virus Resource in NCBI. Phylogenetic study of circulating human pandemic H1N1 virus indicated that the new variant possesses a distinctive evolutionary trait. There is no one way the pandemic H1N1 have acquired new genes from other distinguishable viruses circulating recently in local human, pig or domestic poultry populations from various geographic regions. The extensive genetic diversity among whole segments present in pandemic H1N1 genome suggests that multiple introduction of virus have taken place during the period 1999-2009. The initial interspecies transmission could have occurred in the long-range past and after it the reassortants steps lead to three lineages: classical SIV prevalent in the North America, avian-like SIV in Europe and avian-like related SIV in Asia. This analysis contributes to the evidence that pigs are not the only hosts playing the role of "mixing vessel", as it was suggested for many years. PMID:21033564

Kowalczyk, A; Markowska-Daniel, I

2010-01-01

2

Pandemic swine-origin H1N1 influenza A virus isolates show heterogeneous virulence in macaques.  

Science.gov (United States)

The first influenza pandemic of the new millennium was caused by a newly emerged swine-origin influenza virus (SOIV) (H1N1). This new virus is characterized by a previously unknown constellation of gene segments derived from North American and Eurasian swine lineages and the absence of common markers predictive of human adaptation. Overall, human infections appeared to be mild, but an alarming number of young individuals presented with symptoms atypical for seasonal influenza. The new SOIV also showed a sustained human-to-human transmissibility and higher reproduction ratio than common seasonal viruses, altogether indicating a higher pathogenic potential for this newly emerged virus. To study the virulence of the SOIV, we used a recently established cynomolgus macaque model and compared parameters of clinical disease, virology, host responses, and pathology/histopathology with a current seasonal H1N1 virus. We here show that infection of macaques with two genetically similar but clinically distinct SOIV isolates from the early stage of the pandemic (A/Mexico/4108/2009 and A/Mexico/InDRE4487/2009) resulted in upper and lower respiratory tract infections and clinical disease ranging from mild to severe pneumonia that was clearly advanced over the mild infection caused by A/Kawasaki/UTK-4/2009, a current seasonal strain. Unexpectedly, we observed heterogeneity among the two SOIV isolates in virus replication, host transcriptional and cytokine responses, and disease progression, demonstrating a higher pathogenic potential for A/Mexico/InDRE4487/2009. Differences in virulence may explain more severe disease, as was seen with certain individuals infected with the emerged pandemic influenza virus. Thus, the nonhuman primate model closely mimics influenza in humans. PMID:21084481

Safronetz, David; Rockx, Barry; Feldmann, Friederike; Belisle, Sarah E; Palermo, Robert E; Brining, Douglas; Gardner, Don; Proll, Sean C; Marzi, Andrea; Tsuda, Yoshimi; Lacasse, Rachel A; Kercher, Lisa; York, Anthony; Korth, Marcus J; Long, Dan; Rosenke, Rebecca; Shupert, W Lesley; Aranda, Celia Alpuche; Mattoon, John S; Kobasa, Darwyn; Kobinger, Gary; Li, Yan; Taubenberger, Jeffery K; Richt, Jürgen A; Parnell, Michael; Ebihara, Hideki; Kawaoka, Yoshihiro; Katze, Michael G; Feldmann, Heinz

2011-02-01

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Introduction of Virulence Markers in PB2 of Pandemic Swine-Origin Influenza Virus Does Not Result in Enhanced Virulence or Transmission?  

Science.gov (United States)

In the first 6 months of the H1N1 swine-origin influenza virus (S-OIV) pandemic, the vast majority of infections were relatively mild. It has been postulated that mutations in the viral genome could result in more virulent viruses, leading to a more severe pandemic. Mutations E627K and D701N in the PB2 protein have previously been identified as determinants of avian and pandemic influenza virus virulence in mammals. These mutations were absent in S-OIVs detected early in the 2009 pandemic. Here, using reverse genetics, mutations E627K, D701N, and E677G were introduced into the prototype S-OIV A/Netherlands/602/2009, and their effects on virus replication, virulence, and transmission were investigated. Mutations E627K and D701N caused increased reporter gene expression driven by the S-OIV polymerase complex. None of the three mutations affected virus replication in vitro. The mutations had no major impact on virus replication in the respiratory tracts of mice and ferrets or on pathogenesis. All three mutant viruses were transmitted via aerosols or respiratory droplets in ferrets. Thus, the impact of key known virulence markers in PB2 in the context of current S-OIVs was surprisingly small. This study does not exclude the possibility of emergence of S-OIVs with other virulence-associated mutations in the future. We conclude that surveillance studies aimed at detecting S-OIVs with increased virulence or transmission should not rely solely on virulence markers identified in the past but should include detailed characterization of virus phenotypes, guided by genetic signatures of viruses detected in severe cases of disease in humans. PMID:20130063

Herfst, Sander; Chutinimitkul, Salin; Ye, Jianqiang; de Wit, Emmie; Munster, Vincent J.; Schrauwen, Eefje J. A.; Bestebroer, Theo M.; Jonges, Marcel; Meijer, Adam; Koopmans, Marion; Rimmelzwaan, Guus F.; Osterhaus, Albert D. M. E.; Perez, Daniel R.; Fouchier, Ron A. M.

2010-01-01

4

Swine-origin influenza-virus-induced acute lung injury: Novel or classical pathogenesis?  

Directory of Open Access Journals (Sweden)

Full Text Available Influenza viruses are common respiratory pathogens in humans and can cause serious infection that leads to the development of pneumonia. Due to their host-range diversity, genetic and antigenic diversity, and potential to reassort genetically in vivo, influenza A viruses are continual sources of novel influenza strains that lead to the emergence of periodic epidemics and outbreaks in humans. Thus, newly emerging viral diseases are always major threats to public health. In March 2009, a novel influenza virus suddenly emerged and caused a worldwide pandemic. The novel pandemic influenza virus was genetically and antigenically distinct from previous seasonal human influenza A/H1N1 viruses; it was identified to have originated from pigs, and further genetic analysis revealed it as a subtype of A/H1N1, thus later called a swine-origin influenza virus A/H1N1. Since the novel virus emerged, epidemiological surveys and research on experimental animal models have been conducted, and characteristics of the novel influenza virus have been determined but the exact mechanisms of pulmonary pathogenesis remain to be elucidated. In this editorial, we summarize and discuss the recent pandemic caused by the novel swine-origin influenza virus A/H1N1 with a focus on the mechanism of pathogenesis to obtain an insight into potential therapeutic strategies.

Naoyoshi Maeda

2010-05-01

5

Variant (Swine Origin) Influenza Viruses in Humans  

Science.gov (United States)

... Masks to Control Influenza Transmission Respiratory Hygiene/Cough Etiquette Clinical Description & Lab Diagnosis Influenza Symptoms and the ... 65+ Years Businesses/Employers Health Care Workers American Indian & Alaska Natives Spanish Language Mobile Content Influenza FluView ...

6

Pandemic Influenza in Two Newborns  

Directory of Open Access Journals (Sweden)

Full Text Available The new influenza A (H1N1 virus of swine origin was first described from Mexico in April 2009. Subsequently spreading all over the world, it was considered to be the first pandemic of the 21st century. According to data from the World Health Organization (WHO, the highest disease rates in American and European regions were reported among children and young adults. Despite the highly contagious nature of pandemic influenza, most cases displayed a mild course. WHO declared the risk factors for severe disease in children as ongoing chronic disease, intake of aspirin and age below two-years.The youngest patient reported in the literature is 21 days old. We would like to present two neonatal cases with verified pandemic influenza, who recovered without any complications.

Medine Ay?in Ta?ar

2010-09-01

7

Influenza pandemic planning guide  

Energy Technology Data Exchange (ETDEWEB)

An influenza pandemic will have serious economic impacts on the natural gas industry due to absenteeism as well as downstream effects due to supply disruption.This guide was prepared to assist gas distribution companies in planning for an influenza epidemic. The guide aimed to minimize the risks that an influenza pandemic might pose to the health and safety of employees and the continuity of business operations. The guide discussed 5 critical aspects of emergency planning: (1) prevention and threat mitigation; (2) preparedness; (3) response; (4) business continuity; and (5) communication. The legal context of the emergency plans were discussed. The plans were also discussed to other essential infrastructure emergency response plans. Recommendations were presented for infection control, decentralization and access restriction. Outlines for pandemic response planning teams and training and exercise programs were provided. Issues related to alert, mobilization, and response procedures were also discussed. 10 refs., 3 tabs., 1 fig.

NONE

2006-11-15

8

Influenza pandemics and avian flu  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Douglas Fleming is general practitioner in a large suburban practice in Birmingham. In this article he seeks to clarify clinical issues relating to potential pandemics of influenza, including avian influenza

2005-01-01

9

Improving pandemic influenza risk assessment.  

Science.gov (United States)

Assessing the pandemic risk posed by specific non-human influenza A viruses is an important goal in public health research. As influenza virus genome sequencing becomes cheaper, faster, and more readily available, the ability to predict pandemic potential from sequence data could transform pandemic influenza risk assessment capabilities. However, the complexities of the relationships between virus genotype and phenotype make such predictions extremely difficult. The integration of experimental work, computational tool development, and analysis of evolutionary pathways, together with refinements to influenza surveillance, has the potential to transform our ability to assess the risks posed to humans by non-human influenza viruses and lead to improved pandemic preparedness and response. PMID:25321142

Russell, Colin A; Kasson, Peter M; Donis, Ruben O; Riley, Steven; Dunbar, John; Rambaut, Andrew; Asher, Jason; Burke, Stephen; Davis, C Todd; Garten, Rebecca J; Gnanakaran, Sandrasegaram; Hay, Simon I; Herfst, Sander; Lewis, Nicola S; Lloyd-Smith, James O; Macken, Catherine A; Maurer-Stroh, Sebastian; Neuhaus, Elizabeth; Parrish, Colin R; Pepin, Kim M; Shepard, Samuel S; Smith, David L; Suarez, David L; Trock, Susan C; Widdowson, Marc-Alain; George, Dylan B; Lipsitch, Marc; Bloom, Jesse D

2014-01-01

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The 2009 influenza pandemic: promising lessons for antiviral therapy for future outbreaks.  

Science.gov (United States)

The influenza A virus is the main circulating influenza virus in the human population. It can cause disease also in birds and other mammals and is responsible for annual epidemics and occasional pandemics. The most known and deadly pandemic was the "Spanish flu" (influenza type A/H1N1), which struck the human population between 1918 and 1919, with probably the heaviest toll ever recorded in terms of human lives. The most recent flu pandemic, caused in 2009 by the swine-origin reassortant virus (pH1N1), has raised several critical issues in terms of our preparedness in responding fast to new pandemic influenza strains. Probably, the most instructive lesson that has been learned from the 2009 pandemic, was that the speed of manufacturing and distributing an effective vaccine will not be able to keep up with the pace of a rapidly spreading pandemic virus, failing to grant accessibility to the vaccine for a significant percentage of the susceptible population, before the onset of the pandemic peak. Thus, our first and most effective line of defense against a pandemic influenza virus, particularly in the early phases, are the antiviral drugs. Here we analyze our current understanding of the influenza pandemic viruses, in general, and of the pH1N1 in particular, along with the most recent approaches being pursued to design new anti-influenza drugs. PMID:22087838

Bavagnoli, L; Maga, G

2011-01-01

11

Novel Swine-Origin Influenza A (H1N1) Virus-Associated Hemophagocytic Syndrome—A First Case Report  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Secondary or reactive hemophagocytic syndrome (HPS) is frequently related to viral infections. However, the novel swine-origin influenza A (H1N1) virus associated HPS has never been reported. On October 10, 2009, a 17-year-old female child with no past medical history, complaining of severe asthenia, pneumonia, myalgia, and high fever, was admitted to our department, and H1N1 DNA was detected. Five days after her hospitalization, all signs and symptoms aggravated into HPS. After treatment for...

Zheng, Yishan; Yang, Yongfeng; Zhao, Wei; Wang, Hong

2010-01-01

12

Molecular epidemiology of novel swine origin influenza virus (S-OIV from Gwalior, India, 2009  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background The H1N1pandemic virus is a newly emergent human influenza A virus that is closely related to a number of currently circulating pig viruses in the 'classic North American' and 'Eurasian' swine influenza virus lineages and thus referred as S-OIV. Since the first reports of the virus in humans in April 2009, H1N1 virus has spread to 168 countries and overseas territories. India also witnessed severe H1N1 pandemic virus epidemic with considerable morbidity and mortality in different parts starting from May 2009. Findings The suspected swine flu outbreak from Gwalior India during October- December 2009 was confirmed through S-OIV HA gene specific RT-LAMP and real time RT-PCR. Positive samples through CDC real time and Lamp assay were further processed for isolation of the virus. Full HA gene sequencing of the H1N1 isolates of Gwalior, India revealed 99% homology with California and other circulating novel swine flu viruses. Three major changes were observed at nucleotide level, while two major amino acid shifts were observed at the position C9W and I30M corresponding to the ORF with prototype strain. The HA gene sequence phylogeny revealed the circulation of two genetically distinct lineages belonging to Clade VII and Clade I of S-OIV. Conclusions Our findings also supported the earlier report about circulation of mixed genogroups of S-OIV in India. Therefore continuous monitoring of the genetic makeup of this newly emergent virus is essential to understand its evolution within the country.

Shukla Jyoti

2011-06-01

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Introduction of a Novel Swine-Origin Influenza A (H1N1 Virus into Milwaukee, Wisconsin in 2009  

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Full Text Available On 17 April 2009, novel swine origin influenza A virus (S-OIV cases appeared within the United States. Most influenza A diagnostic assays currently utilized in local clinical laboratories do not allow definitive subtype determination. Detailed subtype analysis of influenza A positive samples in our laboratory allowed early confirmation of a large outbreak of S-OIV in southeastern Wisconsin (SEW. The initial case of S-OIV in SEW was detected on 28 April 2009. All influenza A samples obtained during the 16 week period prior to 28 April 2009, and the first four weeks of the subsequent epidemic were sub typed. Four different multiplex assays were employed, utilizing real time PCR and end point PCR to fully subtype human and animal influenza viral components. Specific detection of S-OIV was developed within days. Data regarding patient demographics and other concurrently circulating viruses were analyzed. During the first four weeks of the epidemic, 679 of 3726 (18.2% adults and children tested for influenza A were identified with S-OIV infection. Thirteen patients (0.34% tested positive for seasonal human subtypes of influenza A during the first two weeks and none in the subsequent 2 weeks of the epidemic. Parainfluenza viruses were the most prevalent seasonal viral agents circulating during the epidemic (of those tested, with detection rates of 12% followed by influenza B and RSV at 1.9% and 0.9% respectively. S-OIV was confirmed on day 2 of instituting subtype testing and within 4 days of report of national cases of S-OIV. Novel surge capacity diagnostic infrastructure exists in many specialty and research laboratories around the world. The capacity for broader influenza A sub typing at the local laboratory level allows timely and accurate detection of novel strains as they emerge in the community, despite the presence of other circulating viruses producing identical illness. This is likely to become increasingly important given the need for appropriate subtype driven anti-viral therapy and the potential shortage of such medications in a large epidemic.

Swati Kumar

2009-06-01

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Infecção pelo vírus Influenza A (H1N1 de origem suína: como reconhecer, diagnosticar e prevenir How to prevent, recognize and diagnose infection with the swine-origin Influenza A (H1N1 virus in humans  

Directory of Open Access Journals (Sweden)

Full Text Available Em março de 2009, houve o início de uma epidemia de gripe no México que, em pouco tempo, levou ao surgimento de casos semelhantes em outros países, alertando as autoridades sanitárias para o risco de uma pandemia. Neste artigo, descrevemos os principais sinais e sintomas da infecção pelo vírus Influenza A (H1N1 de origem suína, as medidas a serem tomadas para os casos suspeitos ou confirmados e como proceder em relação aos contactantes. Comentamos também quais drogas são utilizadas para o tratamento e profilaxia.In March of 2009, a flu epidemic began in Mexico. Shortly thereafter, similar cases appeared in other countries, alerting authorities to the risk of a pandemic. This article details the principal signs and symptoms of infection with the swine-origin Influenza A (H1N1 virus. In addition, the measures to be taken in suspected or confirmed cases are addressed, as are the procedures to follow in relation to contacts. Furthermore, the drugs used in the prophylaxis against and the treatment of infection with the H1N1 virus are described.

Alcyone Artioli Machado

2009-05-01

15

Pandemic Influenza Pediatric Office Plan Template  

Energy Technology Data Exchange (ETDEWEB)

This is a planning tool developed by pediatric stakeholders that is intended to assist pediatric medical offices that have no pandemic influenza plan in place, but may experience an increase in patient calls/visits or workload due to pandemic influenza.

HCTT CHE

2010-01-01

16

Influenza pandemic planning for cancer patients  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Given that an influenza pandemic is likely within the next few years, the World Health Organization has recommended that policymakers take action to mitigate the consequences of such a pandemic. Because of the increased risk of patients with cancer developing complications of influenza, policymakers in cancer care should immediately begin planning for changes to resource allocation, clinical care, and the consent process during a pandemic.

Battershill, P. M.

2006-01-01

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Economic and policy implications of pandemic influenza.  

Energy Technology Data Exchange (ETDEWEB)

Pandemic influenza has become a serious global health concern; in response, governments around the world have allocated increasing funds to containment of public health threats from this disease. Pandemic influenza is also recognized to have serious economic implications, causing illness and absence that reduces worker productivity and economic output and, through mortality, robs nations of their most valuable assets - human resources. This paper reports two studies that investigate both the short- and long-term economic implications of a pandemic flu outbreak. Policy makers can use the growing number of economic impact estimates to decide how much to spend to combat the pandemic influenza outbreaks. Experts recognize that pandemic influenza has serious global economic implications. The illness causes absenteeism, reduced worker productivity, and therefore reduced economic output. This, combined with the associated mortality rate, robs nations of valuable human resources. Policy makers can use economic impact estimates to decide how much to spend to combat the pandemic influenza outbreaks. In this paper economists examine two studies which investigate both the short- and long-term economic implications of a pandemic influenza outbreak. Resulting policy implications are also discussed. The research uses the Regional Economic Modeling, Inc. (REMI) Policy Insight + Model. This model provides a dynamic, regional, North America Industrial Classification System (NAICS) industry-structured framework for forecasting. It is supported by a population dynamics model that is well-adapted to investigating macro-economic implications of pandemic influenza, including possible demand side effects. The studies reported in this paper exercise all of these capabilities.

Smith, Braeton J.; Starks, Shirley J.; Loose, Verne W.; Brown, Theresa Jean; Warren, Drake E.; Vargas, Vanessa N.

2010-03-01

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Infecção pelo vírus Influenza A (H1N1) de origem suína: como reconhecer, diagnosticar e prevenir / How to prevent, recognize and diagnose infection with the swine-origin Influenza A (H1N1) virus in humans  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese Em março de 2009, houve o início de uma epidemia de gripe no México que, em pouco tempo, levou ao surgimento de casos semelhantes em outros países, alertando as autoridades sanitárias para o risco de uma pandemia. Neste artigo, descrevemos os principais sinais e sintomas da infecção pelo vírus Influ [...] enza A (H1N1) de origem suína, as medidas a serem tomadas para os casos suspeitos ou confirmados e como proceder em relação aos contactantes. Comentamos também quais drogas são utilizadas para o tratamento e profilaxia. Abstract in english In March of 2009, a flu epidemic began in Mexico. Shortly thereafter, similar cases appeared in other countries, alerting authorities to the risk of a pandemic. This article details the principal signs and symptoms of infection with the swine-origin Influenza A (H1N1) virus. In addition, the measure [...] s to be taken in suspected or confirmed cases are addressed, as are the procedures to follow in relation to contacts. Furthermore, the drugs used in the prophylaxis against and the treatment of infection with the H1N1 virus are described.

Alcyone Artioli, Machado.

19

Infecção pelo vírus Influenza A (H1N1) de origem suína: como reconhecer, diagnosticar e prevenir / How to prevent, recognize and diagnose infection with the swine-origin Influenza A (H1N1) virus in humans  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese Em março de 2009, houve o início de uma epidemia de gripe no México que, em pouco tempo, levou ao surgimento de casos semelhantes em outros países, alertando as autoridades sanitárias para o risco de uma pandemia. Neste artigo, descrevemos os principais sinais e sintomas da infecção pelo vírus Influ [...] enza A (H1N1) de origem suína, as medidas a serem tomadas para os casos suspeitos ou confirmados e como proceder em relação aos contactantes. Comentamos também quais drogas são utilizadas para o tratamento e profilaxia. Abstract in english In March of 2009, a flu epidemic began in Mexico. Shortly thereafter, similar cases appeared in other countries, alerting authorities to the risk of a pandemic. This article details the principal signs and symptoms of infection with the swine-origin Influenza A (H1N1) virus. In addition, the measure [...] s to be taken in suspected or confirmed cases are addressed, as are the procedures to follow in relation to contacts. Furthermore, the drugs used in the prophylaxis against and the treatment of infection with the H1N1 virus are described.

Alcyone Artioli, Machado.

2009-05-01

20

Health systems planning for an influenza pandemic.  

Science.gov (United States)

District planning, in general, and influenza pandemic planning, in particular, are necessary to sustain health care organizations and systems. An extensive stakeholder process used by Capital District Health Authority (CDHA) and the Izaak Walton Killam (IWK) Health Centre involved more than 25 teams. This work resulted in a joint CDHA/IWK pandemic influenza contingency plan for public health, primary care, acute care and tertiary care services. In addition, district and business continuity planning has been enhanced. PMID:17521070

Graham, Kathleen; Connolly, Maureen

2007-01-01

 
 
 
 
21

Stockpiling supplies for the next influenza pandemic.  

Science.gov (United States)

Faced with increasing concerns about the likelihood of an influenza pandemic, healthcare systems have been challenged to determine what specific medical supplies that should be procured and stockpiled as a component of preparedness. Despite publication of numerous pandemic planning recommendations, little or no specific guidance about the types of items and quantities of supplies needed has been available. The primary purpose of this report is to detail the approach of 1 healthcare system in building a cache of supplies to be used for patient care during the next influenza pandemic. These concepts may help guide the actions of other healthcare systems. PMID:21970033

Radonovich, Lewis J; Magalian, Paul D; Hollingsworth, Mary Kay; Baracco, Gio

2009-06-01

22

Pandemic influenza: implications for occupational medicine  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract This article reviews the biological and occupational medicine literature related to H5N1 pandemic influenza and its impact on infection control, cost and business continuity in settings outside the health care community. The literature on H5N1 biology is reviewed including the treatment and infection control mechanisms as they pertain to occupational medicine. Planning activity for the potential arrival of pandemic avian influenza is growing rapidly. Much has been published on the molecular biology of H5N1 but there remains a paucity of literature on the occupational medicine impacts to organizations. This review summarizes some of the basic science surrounding H5N1 influenza and raises some key concerns in pandemic planning for the occupational medicine professional. Workplaces other than health care settings will be impacted greatly by an H5N1 pandemic and the occupational physician will play an essential role in corporate preparation, response, and business continuity strategies.

Burnstein Matthew D

2009-06-01

23

Pandemic influenza: implications for occupational medicine.  

Science.gov (United States)

This article reviews the biological and occupational medicine literature related to H5N1 pandemic influenza and its impact on infection control, cost and business continuity in settings outside the health care community. The literature on H5N1 biology is reviewed including the treatment and infection control mechanisms as they pertain to occupational medicine. Planning activity for the potential arrival of pandemic avian influenza is growing rapidly. Much has been published on the molecular biology of H5N1 but there remains a paucity of literature on the occupational medicine impacts to organizations. This review summarizes some of the basic science surrounding H5N1 influenza and raises some key concerns in pandemic planning for the occupational medicine professional. Workplaces other than health care settings will be impacted greatly by an H5N1 pandemic and the occupational physician will play an essential role in corporate preparation, response, and business continuity strategies. PMID:19549302

Journeay, W Shane; Burnstein, Matthew D

2009-01-01

24

Protecting residential care facilities from pandemic influenza.  

Science.gov (United States)

It is widely believed that protecting health care facilities against outbreaks of pandemic influenza requires pharmaceutical resources such as antivirals and vaccines. However, early in a pandemic, vaccines will not likely be available and antivirals will probably be of limited supply. The containment of pandemic influenza within acute-care hospitals anywhere is problematic because of open connections with communities. However, other health care institutions, especially those providing care for the disabled, can potentially control community access. We modeled a residential care facility by using a stochastic compartmental model to address the question of whether conditions exist under which nonpharmaceutical interventions (NPIs) alone might prevent the introduction of a pandemic virus. The model projected that with currently recommended staff-visitor interactions and social distancing practices, virus introductions are inevitable in all pandemics, accompanied by rapid internal propagation. The model identified staff reentry as the critical pathway of contagion, and provided estimates of the reduction in risk required to minimize the probability of a virus introduction. By using information on latency for historical and candidate pandemic viruses, we developed NPIs that simulated notions of protective isolation for staff away from the facility that reduced the probability of bringing the pandemic infection back to the facility to levels providing protection over a large range of projected pandemic severities. The proposed form of protective isolation was evaluated for social plausibility by collaborators who operate residential facilities. It appears unavoidable that NPI combinations effective against pandemics more severe than mild imply social disruption that increases with severity. PMID:18647829

Nuño, M; Reichert, T A; Chowell, G; Gumel, A B

2008-07-29

25

Mass vaccination for annual and pandemic influenza.  

Science.gov (United States)

Influenza virus causes annual epidemics and occasional pandemics. Frequent mutations in circulating influenza strains ("antigenic drift") result in the need for annual vaccination. More than two-thirds of persons in the U.S. are recommended for annual vaccination. Because influenza vaccine is available seasonally, mass vaccination strategies are well suited to its delivery. Although doctors offices are the most frequent setting for influenza vaccination overall, workplaces, clinics, and community sites (retail stores and pharmacies) also are common vaccination settings. Influenza vaccination also is delivered in mass vaccination clinics to health care workers and military personnel. Universal influenza vaccination, which has been recommended as a strategy to improve prevention by increasing vaccination coverage and providing indirect protection of adults by decreasing infection and transmission among children, would require expanded use of mass vaccination, for example in schools, as well as in the community. Influenza pandemics occur when a new influenza A subtype is introduced into the population ("antigenic shift"). Most or all of the population is susceptible to the pandemic virus and two doses of vaccine may be needed for protection. U.S. pandemic preparedness and response plans indicate that the entire population should be vaccinated beginning with defined priority groups including those who provide essential services including healthcare and those at highest risk of severe illness and death. Pandemic influenza vaccination will occur primarily through the public sector in mass clinic settings. Vaccination program planning must consider issues including coordination, staffing, clinic location and lay-out, security, record keeping, and communications. Exercising vaccination clinics is important for preparedness and can be done in the context of annual influenza vaccination. PMID:16989268

Schwartz, B; Wortley, P

2006-01-01

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The novel influenza A (H1N1) virus pandemic: An update.  

Science.gov (United States)

In the 4 months since it was first recognized, the pandemic strain of a novel influenza A (H1N1) virus has spread to all continents and, after documentation of human-to-human transmission of the virus in at least three countries in two separate World Health Organization (WHO) regions, the pandemic alert was raised to level 6. The agent responsible for this pandemic, a swine-origin influenza A (H1N1) virus (S-OIV), is characterized by a unique combination of gene segments that has not previously been identified among human or swine influenza A viruses. As of 31th July 2009, 168 countries and overseas territories/communities have each reported at least one laboratory-confirmed case of pandemic H1N1 infection. There have been a total of 162,380 reported cases and 1154 associated deaths. Influenza epidemics usually take off in autumn, and it is important to prepare for an earlier start this season. Estimates from Europe indicate that 230 millions Europe inhabitants will have clinical signs and symptoms of S-OIV this autumn, and 7- 35% of the clinical cases will have a fatal outcome, which means that there will be 160,000- 750,000 H1N1-related deaths. A vaccine against H1N1 is expected to be the most effective tool for controlling influenza A (H1N1) infection in terms of reducing morbidity and mortality and limiting diffusion. However, there are several issues with regard to vaccine manufacture and approval, as well as production capacity, that remain unsettled. We searched the literature indexed in PubMed as well as the websites of major international health agencies to obtain the material presented in this update on the current S-OIV pandemic. PMID:19881161

Petrosillo, N; Di Bella, S; Drapeau, C M; Grilli, E

2009-10-01

27

Substitutions T200A and E227A in the Hemagglutinin of Pandemic 2009 Influenza A Virus Increase Lethality but Decrease Transmission  

Science.gov (United States)

We report that swine influenza virus-like substitutions T200A and E227A in the hemagglutinin (HA) of the 2009 pandemic influenza virus alter its pathogenesis and transmission. Viral replication is increased in mammalian cells. Infected mice show increased disease as measured by weight loss and lethality. Transmission in ferrets is decreased in the presence of both substitutions, suggesting that amino acids 200T and 227E are adaptive changes in the HA of swine origin influenza viruses associated with increased transmission and decreased pathogenesis. PMID:23536663

Martinez-Romero, Carles; de Vries, Erik; Belicha-Villanueva, Alan; Mena, Ignacio; Tscherne, Donna M.; Gillespie, Virginia L.; Albrecht, Randy A.; de Haan, Cornelis A. M.

2013-01-01

28

Colleges and Universities Pandemic Influenza Planning Checklist  

Science.gov (United States)

In the event of an influenza pandemic, colleges and universities will play an integral role in protecting the health and safety of students, employees and their families. The Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC) have developed this checklist as a framework to assist colleges and…

Centers for Disease Control and Prevention, 2006

2006-01-01

29

Co-infection of adenovirus with swine origin influenza A (H1N1 and report of adenovirus with respiratory syncytial virus: report of two cases  

Directory of Open Access Journals (Sweden)

Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Respiratory virus infections represent a major public health problem because of their worldwide occurrence, ease of spread in the community and considerable morbidity and mortality. They are one of the most common reasons for hospitalization of children under the age of six. In some cases, infection with two different viruses increase the severity of disease which lead to the hospitalization."n"nCase presentation: Among 202 samples related to children under the age of six with respiratory infections, two dual infections of Adenovirus with other respiratory viruses with PCR test were detected."n"nConclusion: Mixed respiratory viral infections are sometimes associated with severe disease and recognition of coinfection is important. Dual infections of Adenovirus with respiratory syncytial virus (RSV and Swine origin influenza A (H1N1 virus were demonstrated. The evidence showed that the co-infection of Adenovirus with swine origin influenza A (H1N1, has increased the severity of disease which lead to the hospitalization.

Shatizadeh Malekshahi S

2010-12-01

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Developing Vaccines to Combat Pandemic Influenza  

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Full Text Available Influenza vaccine manufacturers require antigenically relevant vaccine viruses that have good manufacturing properties and are safe to use. In developing pandemic vaccine viruses, reverse genetics has been employed as a rational approach that can also be used effectively to attenuate the highly virulent H5N1 virus and at the same time place the H5 HA and N1 NA on a background of PR8, a virus that has been used over many decades to provide high yielding vaccine viruses. Reverse genetics has also been used successfully alongside classical reassorting techniques in the development of (swine flu pandemic A(H1N1v vaccine viruses.

Othmar G. Engelhardt

2010-02-01

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Anti-viral properties and mode of action of standardized Echinacea purpurea extract against highly pathogenic avian Influenza virus (H5N1, H7N7 and swine-origin H1N1 (S-OIV  

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Full Text Available Abstract Background Influenza virus (IV infections are a major threat to human welfare and animal health worldwide. Anti-viral therapy includes vaccines and a few anti-viral drugs. However vaccines are not always available in time, as demonstrated by the emergence of the new 2009 H1N1-type pandemic strain of swine origin (S-OIV in April 2009, and the acquisition of resistance to neuraminidase inhibitors such as Tamiflu® (oseltamivir is a potential problem. Therefore the prospects for the control of IV by existing anti-viral drugs are limited. As an alternative approach to the common anti-virals we studied in more detail a commercial standardized extract of the widely used herb Echinacea purpurea (Echinaforce®, EF in order to elucidate the nature of its anti-IV activity. Results Human H1N1-type IV, highly pathogenic avian IV (HPAIV of the H5- and H7-types, as well as swine origin IV (S-OIV, H1N1, were all inactivated in cell culture assays by the EF preparation at concentrations ranging from the recommended dose for oral consumption to several orders of magnitude lower. Detailed studies with the H5N1 HPAIV strain indicated that direct contact between EF and virus was required, prior to infection, in order to obtain maximum inhibition in virus replication. Hemagglutination assays showed that the extract inhibited the receptor binding activity of the virus, suggesting that the extract interferes with the viral entry into cells. In sequential passage studies under treatment in cell culture with the H5N1 virus no EF-resistant variants emerged, in contrast to Tamiflu®, which produced resistant viruses upon passaging. Furthermore, the Tamiflu®-resistant virus was just as susceptible to EF as the wild type virus. Conclusion As a result of these investigations, we believe that this standard Echinacea preparation, used at the recommended dose for oral consumption, could be a useful, readily available and affordable addition to existing control options for IV replication and dissemination.

Schoop Roland

2009-11-01

32

Distribution of sialic acid receptors and influenza A virus of avian and swine origin in experimentally infected pigs  

DEFF Research Database (Denmark)

Pigs are considered susceptible to influenza A virus infections from different host origins because earlier studies have shown that they have receptors for both avian (sialic acid-alpha-2,3-terminal saccharides (SA-alpha-2,3)) and swine/human (SA-alpha-2,6) influenza viruses in the upper respiratory tract. Furthermore, experimental and natural infections in pigs have been reported with influenza A virus from avian and human sources.

Trebbien, Ramona; Larsen, Lars Erik

2011-01-01

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The Australian response: pandemic influenza preparedness.  

Science.gov (United States)

Australia's preparedness for a potential influenza pandemic involves many players, from individual health carers to interdepartmental government committees. It embraces a wide number of strategies from the management of the disease to facilitating business continuity. The key strategy underlying Australia's planned response is an intensive effort to reduce transmission of the virus. This includes actions to reduce the likelihood of entry of the virus into the country and to contain outbreaks when they occur. Containment will provide time to allow production of a matched vaccine. The health strategies are outlined in the Australian health management plan for pandemic influenza. The plan is accompanied by technical annexes setting out key considerations and guidelines in the areas of clinical management and infection control. National plans present overall strategies and guidance, but the operational details can only be determined by individual states and territories, regions, and the services themselves. Primary health care practices will be on the frontline of an influenza pandemic. Every practice needs a plan that defines the roles of staff, incorporates infection control and staff protection measures, and considers business continuity. Most importantly, a practice needs to know how to implement that plan. PMID:17115949

Horvath, John S; McKinnon, Moira; Roberts, Leslee

2006-11-20

34

Influenza pandemics: past, present and future challenges  

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Full Text Available Influenza epidemics occur regularly and prediction of their conversion to pandemics and their impact is difficult. Coordination of efforts on a global scale to control or reduce the impact is fraught with potential for under and overreaction. In light of the 1956 pandemic and more recently the SARS and H1N1 pandemics, the public health community took steps toward strengthening global surveillance and a coordinated response in keeping with the continuing memory of the tragedy seen in 1918. The scientific, professional, and technical resources of the 21st century are now advanced far beyond those then available. The H1N1 pandemic which commenced in 2009 progressed differently than predicted; its course was difficult to predict with any degree of certainty. Public responses to national immunization programs against the H1N1 virus have been weak. International movement of diseases can lead to creation of new endemic areas and continuous spread such as that which happened with West Nile Fever and Chikungunya. The lessons learned and the public and political responses to each actual or threatened pandemic will serve public health well in dealing with future challenges.

Zylberman Patrick

2010-07-01

35

Distribution of sialic acid receptors and influenza A virus of avian and swine origin in experimentally infected pigs  

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Full Text Available Abstract Background Pigs are considered susceptible to influenza A virus infections from different host origins because earlier studies have shown that they have receptors for both avian (sialic acid-alpha-2,3-terminal saccharides (SA-alpha-2,3 and swine/human (SA-alpha-2,6 influenza viruses in the upper respiratory tract. Furthermore, experimental and natural infections in pigs have been reported with influenza A virus from avian and human sources. Methods This study investigated the receptor distribution in the entire respiratory tract of pigs using specific lectins Maackia Amurensis (MAA I, and II, and Sambucus Nigra (SNA. Furthermore, the predilection sites of swine influenza virus (SIV subtypes H1N1 and H1N2 as well as avian influenza virus (AIV subtype H4N6 were investigated in the respiratory tract of experimentally infected pigs using immunohistochemical methods. Results SIV antigen was widely distributed in bronchi, but was also present in epithelial cells of the nose, trachea, bronchioles, and alveolar type I and II epithelial cells in severely affected animals. AIV was found in the lower respiratory tract, especially in alveolar type II epithelial cells and occasionally in bronchiolar epithelial cells. SA-alpha-2,6 was the predominant receptor in all areas of the respiratory tract with an average of 80-100% lining at the epithelial cells. On the contrary, the SA-alpha-2,3 was not present (0% at epithelial cells of nose, trachea, and most bronchi, but was found in small amounts in bronchioles, and in alveoli reaching an average of 20-40% at the epithelial cells. Interestingly, the receptor expression of both SA-alpha-2,3 and 2,6 was markedly diminished in influenza infected areas compared to non-infected areas. Conclusions A difference in predilection sites between SIV and AIV virus was found, and this difference was in accordance with the distribution of the SA-alpha-2,6 and SA-alpha-2,3 receptor, respectively. The results indicated that the distribution of influenza A virus receptors in pigs are similar to that of humans and therefore challenge the theory that the pig acts as a mixing vessel between human and avian influenza viruses. Furthermore, it was shown that AIV prefers to infect alveolar type II epithelial cells in pigs. This corresponds with findings in humans emphasising the resemblance between the two species.

Viuff Birgitte M

2011-09-01

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Avian Influenza Virus: The Threat of A Pandemic  

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Full Text Available The 1918 influenza A virus pandemic caused a death toll of 40~50 million. Currently,because of the widespread dissemination of the avian influenza virus (H5N1, there is a highrisk of another pandemic. Avian species are the natural hosts for numerous subtypes ofinfluenza A viruses; however, the highly pathogenic avian influenza virus (HPAI is not onlyextremely lethal to domestic avian species but also can infect humans and cause death. Thisreview discusses why the avian influenza virus is considered the most likely candidate forthe first flu pandemic of the 21st century

Shih-Cheng Chang

2006-04-01

37

76 FR 58466 - Request for Comments on World Health Organization Pandemic Influenza Preparedness Framework  

Science.gov (United States)

...Request for Comments on World Health Organization Pandemic Influenza Preparedness...including implementation of the World Health Organization Pandemic Influenza Preparedness...light of the approval of the World Health Organization (WHO) Pandemic...

2011-09-21

38

Updated preparedness and response framework for influenza pandemics.  

Science.gov (United States)

The complexities of planning for and responding to the emergence of novel influenza viruses emphasize the need for systematic frameworks to describe the progression of the event; weigh the risk of emergence and potential public health impact; evaluate transmissibility, antiviral resistance, and severity; and make decisions about interventions. On the basis of experience from recent influenza responses, CDC has updated its framework to describe influenza pandemic progression using six intervals (two prepandemic and four pandemic intervals) and eight domains. This updated framework can be used for influenza pandemic planning and serves as recommendations for risk assessment, decision-making, and action in the United States. The updated framework replaces the U.S. federal government stages from the 2006 implementation plan for the National Strategy for Pandemic Influenza (US Homeland Security Council. National strategy for pandemic influenza: implementation plan. Washington, DC: US Homeland Security Council; 2006. Available at http://www.flu.gov/planning-preparedness/federal/pandemic-influenza-implementation.pdf). The six intervals of the updated framework are as follows: 1) investigation of cases of novel influenza, 2) recognition of increased potential for ongoing transmission, 3) initiation of a pandemic wave, 4) acceleration of a pandemic wave, 5) deceleration of a pandemic wave, and 6) preparation for future pandemic waves. The following eight domains are used to organize response efforts within each interval: incident management, surveillance and epidemiology, laboratory, community mitigation, medical care and countermeasures, vaccine, risk communications, and state/local coordination. Compared with the previous U.S. government stages, this updated framework provides greater detail and clarity regarding the potential timing of key decisions and actions aimed at slowing the spread and mitigating the impact of an emerging pandemic. Use of this updated framework is anticipated to improve pandemic preparedness and response in the United States. Activities and decisions during a response are event-specific. These intervals serve as a reference for public health decision-making by federal, state, and local health authorities in the United States during an influenza pandemic and are not meant to be prescriptive or comprehensive. This framework incorporates information from newly developed tools for pandemic planning and response, including the Influenza Risk Assessment Tool and the Pandemic Severity Assessment Framework, and has been aligned with the pandemic phases restructured in 2013 by the World Health Organization. PMID:25254666

Holloway, Rachel; Rasmussen, Sonja A; Zaza, Stephanie; Cox, Nancy J; Jernigan, Daniel B

2014-09-26

39

Abbreviated Pandemic Influenza Planning Template for Primary Care Offices  

Energy Technology Data Exchange (ETDEWEB)

The Abbreviated Pandemic Influenza Plan Template for Primary Care Provider Offices is intended to assist primary care providers and office managers with preparing their offices for quickly putting a plan in place to handle an increase in patient calls and visits, whether during the 2009-2010 influenza season or future influenza seasons.

HCTT CHE

2010-01-01

40

Barriers to pandemic influenza vaccination and uptake of seasonal influenza vaccine in the post-pandemic season in Germany  

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Full Text Available Abstract Background In Germany, annual vaccination against seasonal influenza is recommended for certain target groups (e.g. persons aged ?60 years, chronically ill persons, healthcare workers (HCW. In season 2009/10, vaccination against pandemic influenza A(H1N1pdm09, which was controversially discussed in the public, was recommended for the whole population. The objectives of this study were to assess vaccination coverage for seasonal (seasons 2008/09-2010/11 and pandemic influenza (season 2009/10, to identify predictors of and barriers to pandemic vaccine uptake and whether the controversial discussions on pandemic vaccination has had a negative impact on seasonal influenza vaccine uptake in Germany. Methods We analysed data from the ‘German Health Update’ (GEDA10 telephone survey (n=22,050 and a smaller GEDA10-follow-up survey (n=2,493, which were both representative of the general population aged ?18 years living in Germany. Results Overall only 8.8% of the adult population in Germany received a vaccination against pandemic influenza. High socioeconomic status, having received a seasonal influenza shot in the previous season, and belonging to a target group for seasonal influenza vaccination were independently associated with the uptake of pandemic vaccines. The main reasons for not receiving a pandemic vaccination were ‘fear of side effects’ and the opinion that ‘vaccination was not necessary’. Seasonal influenza vaccine uptake in the pre-pandemic season 2008/09 was 52.8% among persons aged ?60 years; 30.5% among HCW, and 43.3% among chronically ill persons. A decrease in vaccination coverage was observed across all target groups in the first post-pandemic season 2010/11 (50.6%, 25.8%, and 41.0% vaccination coverage, respectively. Conclusions Seasonal influenza vaccination coverage in Germany remains in all target groups below 75%, which is a declared goal of the European Union. Our results suggest that controversial public discussions about safety and the benefits of pandemic influenza vaccination may have contributed to both a very low uptake of pandemic vaccines and a decreased uptake of seasonal influenza vaccines in the first post-pandemic season. In the upcoming years, the uptake of seasonal influenza vaccines should be carefully monitored in all target groups to identify if this trend continues and to guide public health authorities in developing more effective vaccination and communication strategies for seasonal influenza vaccination.

Böhmer Merle M

2012-10-01

 
 
 
 
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Methods for molecular surveillance of influenza  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Molecular-based techniques for detecting influenza viruses have become an integral component of human and animal surveillance programs in the last two decades. The recent pandemic of the swine-origin influenza A virus (H1N1) and the continuing circulation of highly pathogenic avian influenza A virus (H5N1) further stress the need for rapid and accurate identification and subtyping of influenza viruses for surveillance, outbreak management, diagnosis and treatment. There has been remarkable pr...

Wang, Ruixue; Taubenberger, Jeffery K.

2010-01-01

42

MF59-adjuvanted vaccines for seasonal and pandemic influenza prophylaxis.  

Science.gov (United States)

Influenza is a major cause of worldwide morbidity and mortality through frequent seasonal epidemics and infrequent pandemics. Morbidity and mortality rates from seasonal influenza are highest in the most frail, such as the elderly, those with underlying chronic conditions and very young children. Antigenic mismatch between strains recommended for vaccine formulation and circulating viruses can further reduce vaccine efficacy in these populations. Seasonal influenza vaccines with enhanced, cross-reactive immunogenicity are needed to address these problems and can confer a better immune protection, particularly in seasons were antigenic mismatch occurs. A related issue for vaccine development is the growing threat of pandemic influenza caused by H5N1 avian strains. Vaccines against strains with pandemic potential offer the best approach for reducing the potential impact of a pandemic. However, current non-adjuvanted pre-pandemic vaccines offer suboptimal immunogenicity against H5N1. For both seasonal and pre-pandemic vaccines, the addition of adjuvants may be the best approach for providing enhanced cross-reactive immunogenicity. MF59, the first oil-in-water emulsion licensed as an adjuvant for human use, can enhance vaccine immune responses through multiple mechanisms. A trivalent MF59-adjuvanted seasonal influenza vaccine (Fluad has shown to induce significantly higher immune responses to influenza vaccination in the elderly, compared with non-adjuvanted vaccines, and to provide cross-reactive immunity against divergent influenza strains. Similar results have been generated with a MF59-adjuvanted H5N1 pre-pandemic vaccine, which showed higher and broader immunogenicity compared with non-adjuvanted pre-pandemic vaccines. PMID:19453401

Banzhoff, Angelika; Pellegrini, Michele; Del Giudice, Giuseppe; Fragapane, Elena; Groth, Nicola; Podda, Audino

2008-11-01

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High-resolution computed tomography findings of swine-origin influenza A (H1N1) virus (S-OIV) infection: comparison with scrub typhus  

Energy Technology Data Exchange (ETDEWEB)

Background. Swine-origin influenza A (H1N1) virus (S-OIV) infection and scrub typhus, also known as tsutsugamushi disease can manifest as acute respiratory illnesses, particularly during the late fall or early winter, with similar radiographic findings, such as a predominance of ground-glass opacity (GGO). Purpose. To differentiate S-OIV infection from scrub typhus using high-resolution computed tomography (HRCT). Material and Methods. We retrospectively reviewed the HRCT findings of 14 patients with S-OIV infection and 10 patients with scrub typhus. We assessed the location, cross-sectional distribution, and the presence of a peribronchovascular distribution of GGO and consolidations on HRCT. We also assessed the presence of interlobular septal thickening, bronchial wall thickening, pneumothorax, pneumomediastinum, pleural effusion, and mediastinal or axillary lymph node enlargement. Results. Scrub typhus was more common than S-OIV in elderly patients (P < 0.001). The monthly incidences of S-OIV and scrub typhus infection reached a peak between October and November. About 86% of S-OIV patients and 80% of scrub typhus patients presented with GGO. About 67% of the GGO lesions in S-OIV had a peribronchovascular distribution, but this was absent in scrub typhus (P = 0.005). Consolidation (93% vs. 10%, P < 0.001) and bronchial wall thickening (43% vs. 0%, P = 0.024) were more frequent in S-OIV infection than scrub typhus. Interlobular septal thickening (90% vs. 36%, P = 0.013) and axillary lymphadenopathy (90% vs. 0%, P < 0.001) were more common in scrub typhus than S-OIV infection. Conclusion. There was considerable overlap in HRCT findings between S-OIV infection and scrub typhus. However, S-OIV showed a distinctive peribronchovascular distribution of GGO lesions. Consolidation and bronchial wall thickening were seen more frequently in S-OIV infection, whereas interlobular septal thickening and axillary lymphadenopathy were more common in scrub typhus. Thus, CT could be helpful for differential diagnosis between S-OIV infection and scrub typhus.

Jo, Bang Sil; Lee, In Jae; Lee, Kwanseop [Dept. of Radiology, Hallym Univ. College of Medicine, Seoul (Korea, Republic of)], E-mail: ijlee2003@medimail.co.kr; Im, Hyoung June [Dept. of Occupational Medicine, Hallym Univ. College of Medicine, Seoul (Korea, Republic of)

2012-07-15

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Pandemic influenza: A global challenge for social marketing marketing  

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Full Text Available Recent years have seen increased attention and concern regarding the potential for pandemic influenza, following large-scale outbreaks of swine flu and bird flu. Governments and health agencies have time to develop social marketing strategies and specific messages that have the potential to minimize fear, refute or inoculate against misinformation that the public may encounter, and enhance the likelihood of the public taking the recommended preventive and remedial actions should these become necessary. This paper presents an overview of how social marketing can be used to tackle the global challenge of pandemic influenza. The potential pandemic influenza poses a major challenge for social marketers (along with governments, health services, and businesses. There are a number of critical factors about a potential pandemic influenza that make it fundamentally different to the majority of issues to which social marketing has previously been applied. The underlying principles of social marketing are equally applicable to a global infectious disease outbreak (such as pandemic influenza. Even if the current strains do not become pandemic, social marketers should use this impetus to develop the skills and resources to address future communicable disease outbreaks. This paper applies the concepts of social marketing to a unique health issue which has the potential to become one of the largest global public health crises in history, but which can be tackled with effective global social marketing.

Sandra C. Jones

2012-10-01

45

Conserved amino acid markers from past influenza pandemic strains  

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Full Text Available Abstract Background Finding the amino acid mutations that affect the severity of influenza infections remains an open and challenging problem. Of special interest is better understanding how current circulating influenza strains could evolve into a new pandemic strain. Influenza proteomes from distinct viral phenotype classes were searched for class specific amino acid mutations conserved in past pandemics, using reverse engineered linear classifiers. Results Thirty-four amino acid markers associated with host specificity and high mortality rate were found. Some markers had little impact on distinguishing the functional classes by themselves, however in combination with other mutations they improved class prediction. Pairwise combinations of influenza genomes were checked for reassortment and mutation events needed to acquire the pandemic conserved markers. Evolutionary pathways involving H1N1 human and swine strains mixed with avian strains show the potential to acquire the pandemic markers with a double reassortment and one or two amino acid mutations. Conclusion The small mutation combinations found at multiple protein positions associated with viral phenotype indicate that surveillance tools could monitor genetic variation beyond single point mutations to track influenza strains. Finding that certain strain combinations have the potential to acquire pandemic conserved markers through a limited number of reassortment and mutation events illustrates the potential for reassortment and mutation events to lead to new circulating influenza strains.

Vitalis Elizabeth A

2009-04-01

46

Modelling the effect of seasonal influenza vaccination on the risk of pandemic influenza infection  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Abstract Background Recent studies have suggested that vaccination with seasonal influenza vaccine resulted in an apparent higher risk of infection with pandemic influenza H1N1 2009. A simple mathematical model incorporating strain competition and a hypothesised temporary strain-transcending immunity is constructed to investigate this observation. The model assumes that seasonal vaccine has no effect on the risk of infection with pandemic influenza. Results Resu...

Barry Steven I; Mercer Geoffry N; Kelly Heath

2011-01-01

47

Pandemic H1N1 2009 Influenza A Virus Induces Weak Cytokine Response in Human Macrophages and Dendritic Cells and Is Highly Sensitive to Antiviral Actions of Interferons  

DEFF Research Database (Denmark)

In less than three months after the first cases of swine-origin 2009 influenza A (H1N1) virus infections were reported from Mexico, WHO declared a pandemic. The pandemic virus is antigenically distinct from seasonal influenza viruses and the majority of human population lacks immunity against this virus. We have studied the activation of innate immune responses in pandemic virus-infected human monocyte-derived dendritic cells (DC) and macrophages. Pandemic A/Finland/553/2009 virus, representing a typical North American/European lineage virus, replicated very well in these cells. The pandemic virus, as well as the seasonal A/Brisbane/59/07 (H1N1) and A/New Caledonia/20/99 (H1N1) viruses, induced type I (IFN-alpha/beta) and type III (IFN-lambda1-3) IFN, CXCL10 and TNF-alpha gene expression weakly in DCs. Mouse adapted A/WSN/33 (H1N1) and human A/Udorn/72 (H3N2) viruses, instead, induced efficiently the expression of antiviral and proinflammatory genes. Both IFN-alpha and IFN-beta inhibited the replication of the pandemic (H1N1) virus. The potential of IFN-lambda3 to inhibit the viral replication was lower than that of type I IFNs. However, the pandemic virus was more sensitive to the antiviral IFN-lambda3 than the seasonal A/Brisbane/59/07 (H1N1) virus. The present study demonstrates that the novel pandemic (H1N1) influenza A virus can readily replicate in human primary DCs and macrophages and efficiently avoid the activation of innate antiviral responses. It is, however, highly sensitive to the antiviral actions of IFNs, which may provide us an additional means to treat severe cases of infection especially if a significant drug resistance will emerge.

Osterlund, Pamela; Pirhonen, Jaana

2010-01-01

48

Contribución del Laboratorio Nacional de Influenza al enfrentamiento de la influenza pandémica 2009 en Cuba / Contribution of the National Influenza Laboratory to confront the 2009 pandemic influenza in Cuba  

Scientific Electronic Library Online (English)

Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish INTRODUCCIÓN: las infecciones respiratorias agudas son consideradas la causa más importante de morbilidad y mortalidad en todo el mundo. Estas infecciones adquieren mayor significación asociadas a eventos epidémicos y pandémicos ocasionados por los virus influenza. La necesidad de una vigilancia mun [...] dial para los virus influenza fue reconocida en 1947 y condujo a la creación de la Red Global de Vigilancia de los virus influenza por la Organización Mundial de la Salud. El Centro Nacional de Influenza de Cuba pertenece a esta red desde 1975. En el mes de abril de 2009 fue reconocido un nuevo virus influenza A (H1N1) de origen porcino que circulaban en humanos, identificado como el agente causal de la primera pandemia del siglo xxi por la Organización Mundial de la Salud. OBJETIVO: llevar a cabo la vigilancia nacional del nuevo virus pandémico. MÉTODOS: el Centro Nacional de Influenza de Cuba desarrolló y organizó un diagrama de diagnóstico para la confirmación en casos sospechosos de infección por este virus. Se emplearon diferentes ensayos de trancripción reversa-reacción en cadena de la polimerasa para el tipado y subtipado de los virus influenza A. RESULTADOS: entre abril y diciembre de 2009, un total de 6 900 muestras clínicas respiratorias fueron procesadas mediante el diagrama diagnóstico nacional y 980 casos fueron confirmados y notificados a las autoridades nacionales de salud y la Organización Panamericana de la Salud. Los rinovirus humanos resultaron otro de los agentes etiológicos de infecciones respiratorias agudas detectados con frecuencia. CONCLUSIÓN: mediante la estrategia nacional de vigilancia de laboratorio fue posible llevar a cabo un monitoreo efectivo de la circulación de los virus influenza y otros virus respiratorios para alertar a las autoridades nacionales de salud, con vistas a enfrentar la influenza pandémica 2009. Abstract in english INTRODUCTION: acute respiratory infections are considered the most important causes of morbidity and mortality around the world. These infections became more significant when associated to epidemics and pandemic events caused by influenza virus. The need for global surveillance of influenza viruses [...] was recognized as early as 1947 and led to the establishment of the World Health Organization (WHO) Global Influenza Surveillance Network (GISN). The Cuban National Influenza Centre (NIC) belongs to this network since 1975. On April 2009, the recognition of a new influenza A (H1N1) of swine origin circulating in humans was identified as the causative agent of the first pandemic in the 21st century declared by the WHO. OBJECTIVE: to carry out surveillance of the new pandemic virus nationwide. METHODS: the Cuban National Influenza Center developed a diagnostic diagram to confirm infection with the pandemic virus in suspected cases. Different PCR assays for typing and subtyping of influenza A virus were used. RESULTS: from April to December 2009, 6 900 clinical respiratory samples were processed by using this diagram, 980 cases were confirmed and notified to the national health authorities and to the Pan American Health Organization. Human rhinoviruses were other important etiologic agents of the frequently detected acute respiratory infections. CONCLUSION: with the national strategy for surveillance at lab, it was possible to effectively monitor the circulation of the influenza viruses and of other respiratory viruses in our country and to alert the national health authorities, with a view to facing up to the pandemic influenza (2009)

Belsy, Acosta Herrera; Alexander, Piñón Ramos; Odalys, Valdés Ramírez; Clara, Savón Valdés; María Guadalupe, Guzmán Tirado; Alina, Llop Hernández; Amely, Arencibia García; Elias, Guilarte García; Grehete, González Muñoz; Guelsys, González Báez; Suset, Oropesa Fernández; Bárbara, Hernández Espinosa; Ángel, Goyenechea Hernández; Vivian, Kourí Cardellá; Luis, Morier Díaz; María Josefa, Llanes Cordero; Nilvia, Herrada Rodríguez.

2011-04-01

49

Death Patterns during the 1918 Influenza Pandemic in Chile.  

Science.gov (United States)

Scarce information about the epidemiology of historical influenza pandemics in South America prevents complete understanding of pandemic patterns throughout the continent and across different climatic zones. To fill gaps with regard to spatiotemporal patterns of deaths associated with the 1918 influenza pandemic in Chile, we reviewed archival records. We found evidence that multiple pandemic waves at various times of the year and of varying intensities occurred during 1918-1921 and that influenza-related excess deaths peaked during July-August 1919. Pandemic-associated mortality rates were elevated for all age groups, including for adults >50 years of age; elevation from baseline was highest for young adults. Overall, the rate of excess deaths from the pandemic was estimated at 0.94% in Chile, similar to rates reported elsewhere in Latin America, but rates varied ?10-fold across provinces. Patterns of death during the pandemic were affected by variation in host-specific susceptibility, population density, baseline death rate, and climate. PMID:25341056

Chowell, Gerardo; Simonsen, Lone; Flores, Jose; Miller, Mark A; Viboud, Cécile

2014-11-01

50

Mobilising "vulnerability" in the public health response to pandemic influenza.  

Science.gov (United States)

Analysis of public health's growing interest in "vulnerability" has largely focused on health policy, with little interrogation of how vulnerability is being actively appropriated, countered, ignored or reworked by the publics whose health such policy is designed to protect. Once the assemblage of public health is understood as comprised of different forms of expertise and actors, including publics, addressing this gap matters. We examine the use of vulnerability in the specific context of pandemic influenza preparedness. Pandemic preparedness raises some familiar dilemmas for public health governance: how to engage with publics without fuelling social divisions and disruption; and whether to invoke publics as passive recipients of public health advice or to recognise publics as collective agents responding to the threat of pandemic influenza. Thus, we ask how the mobilisation of vulnerability connects with these dilemmas. To examine vulnerability in pandemic preparedness, two forms of qualitative data are analysed: 1) interviews and focus groups with "vulnerable" and "healthy" people (conducted 2011-12) discussing seasonal and pandemic influenza and; 2) international, Australian national and state level pandemic plans (1999-2013). Vulnerability is variously used in plans as a way to identify groups at particular risk of infection because of pre-existing clinical conditions, and as a free-floating social category that could apply to a broad range of people potentially involved in the social disruption a pandemic might entail. Our interview and focus group data indicate that healthy people rework the free-floating extension of vulnerability, and that people designated vulnerable encounter an absence of any collective responsibility for the threat of pandemic influenza. Our analysis suggests that vulnerability's mobilisation in pandemic preparedness limits the connection between public health governance and its publics: here, the openness and unpredictability of people's collective agency is something to be tightly controlled by a government concerned with protecting people from themselves. PMID:24565136

Stephenson, Niamh; Davis, Mark; Flowers, Paul; MacGregor, Casimir; Waller, Emily

2014-02-01

51

The effective reproduction number of pandemic influenza: Prospective estimation  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Background: Timely estimation of the transmissibility of a novel pandemic influenza virus was a public health priority in 2009. Methods: We extended methods for prospective estimation of the effective reproduction number (R t) over time in an emerging epidemic to allow for reporting delays and repeated importations. We estimated Rt based on case notifications and hospitalizations associated with laboratory-confirmed pandemic (H1N1) 2009 virus infections in Hong Kong from June through October ...

Cowling, Benjamin J.; Lau, Max S. Y.; Ho, Lai-ming; Chuang, Shuk-kwan; Tsang, Thomas; Liu, Shao-haei; Leung, Pak-yin; Lo, Su-vui; Lau, Eric H. Y.

2010-01-01

52

Rapid detection of pandemic influenza in the presence of seasonal influenza  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Abstract Background Key to the control of pandemic influenza are surveillance systems that raise alarms rapidly and sensitively. In addition, they must minimise false alarms during a normal influenza season. We develop a method that uses historical syndromic influenza data from the existing surveillance system 'SERVIS' (Scottish Enhanced Respiratory Virus Infection Surveillance) for influenza-like illness (ILI) in Scotland. Methods We develop an algorithm based ...

Robertson Chris; Ferguson Neil M; Savill Nicholas J; Singh Brajendra K; Ej, Woolhouse Mark

2010-01-01

53

[Tetravaccine--new fundamental approach to prevention of influenza pandemic].  

Science.gov (United States)

According to opinion of WHO's experts, development and use of tetravaccine, which contains both interdemic and pandemic (H5N1) serotypes of influenza viruses, is one of the most promising approaches to control possible influenza pandemic. Results of recently obtained data from clinical trials allowed experts from WHO to make a conclusion that protective immunity against avian influenza virus can be achieved after 2-doses immunization, when the immune system will be primed to hemagglutinin after the 1st dose and sufficient protective immunity level will be formed after the 2nd dose. However, in case of real threat of pandemic, the time for immunization with 2 doses of the vaccine will be absent. In order to provide protection for population of Russia in a limited time frame it is reasonable to vaccinate them with H5 hemagglutinin beforehand. In that case, when real threat of pandemic will arise, not two but one injection with monovalent vaccine against avian influenza will be sufficient. This idea formed the basis for concept of development of tetravaccine. The essence of the concept is vaccination of population with tetravaccine, consisting of antigens of influenza virus serotypes H3N2, H1N1, B, and H5, before the influenza pandemic caused by H5N1 virus will begin. Such vaccination will induce immunologic memory to hemagglutinin of avian influenza virus serotype H5 and, when the real threat of the pandemic will occur, only single immunization with monovaccine against avian influenza instead of 2 doses will be required. In 2006 Scientific-Production Association "Microgen" conducted extended preclinical study of immunogenic and protective characteristics of candidate vaccines against avian influenza prepared from vaccine strains of H5N1 and H5N2 serotypes. It has been shown that candidate vaccines prepared from both strains have high protective ability against Russian epidemic isolate A/chicken/Kurgan/Russia/2/2005(H5N1). To this time Scientific-Production Association "Microgen" has produced monovalent bulk of H3N2, H1N1, and B serotypes, which are included in interdemic influenza vaccines, as well as monovalent bulk of H5N1 and H5N2 serotypes. This intermediate products are ready to be produced into tetravaccine for conducting extended preclinical studies of its safety, reactogenicity, immunogenicity, and protective properties. If results of such studies will be positive then it is possible to begin clinical trials of the tetravaccine in 2007 and to discuss the questions about its dosage, methods of challenge and schedule. PMID:17882832

Onishchenko, G G; Zverev, V V; Katlinski?, A V; Semchenko, A V; Korovkin, S A; Mel'nikov, S Ia; Mironov, A N

2007-01-01

54

Community Assessment Tool for Public Health Emergencies Including Pandemic Influenza  

Energy Technology Data Exchange (ETDEWEB)

The Community Assessment Tool (CAT) for Public Health Emergencies Including Pandemic Influenza (hereafter referred to as the CAT) was developed as a result of feedback received from several communities. These communities participated in workshops focused on influenza pandemic planning and response. The 2008 through 2011 workshops were sponsored by the Centers for Disease Control and Prevention (CDC). Feedback during those workshops indicated the need for a tool that a community can use to assess its readiness for a disaster—readiness from a total healthcare perspective, not just hospitals, but the whole healthcare system. The CAT intends to do just that—help strengthen existing preparedness plans by allowing the healthcare system and other agencies to work together during an influenza pandemic. It helps reveal each core agency partners' (sectors) capabilities and resources, and highlights cases of the same vendors being used for resource supplies (e.g., personal protective equipment [PPE] and oxygen) by the partners (e.g., public health departments, clinics, or hospitals). The CAT also addresses gaps in the community's capabilities or potential shortages in resources. While the purpose of the CAT is to further prepare the community for an influenza pandemic, its framework is an extension of the traditional all-hazards approach to planning and preparedness. As such, the information gathered by the tool is useful in preparation for most widespread public health emergencies. This tool is primarily intended for use by those involved in healthcare emergency preparedness (e.g., community planners, community disaster preparedness coordinators, 9-1-1 directors, hospital emergency preparedness coordinators). It is divided into sections based on the core agency partners, which may be involved in the community's influenza pandemic influenza response.

HCTT-CHE

2011-04-14

55

INFLUENZA A H1N1 DE ORIGEN PORCINO: Métodos diagnósticos / Influenza A H1N1 swine origin: diagnostic methods  

Scientific Electronic Library Online (English)

Full Text Available SciELO Colombia | Language: Spanish Abstract in spanish El diagnóstico de la infección por virus influenza reposa sobre técnicas virológicas directas e indirectas. Las diferentes pruebas diagnósticas poseen niveles de sensibilidad y especificidad variables que dependen en gran parte de las características genéticas y antigénicas del virus circulante. En [...] el caso de la aparición de una nueva variante viral las pruebas disponibles en el mercado deben ser validadas para comprobar su eficiencia de detección para el nuevo virus. En caso de baja sensibilidad y especificidad, las pruebas deben ajustarse con el fin de mejorar su poder de detección del nuevo agente. Existen múltiples pruebas diagnósticas que presentan cada una sus ventajas y limitaciones y su selección dependerá de las condiciones específicas de cada laboratorio diagnóstico. Abstract in english The diagnosis of infection by influenza viruses relays on direct and indirect virologic techniques. Different diagnostic tests have variable sensitivities and specificities depending to a large extent on the genetic and antigenic features of the circulating virus. When a new viral variant appears, c [...] ommercially available tests must be validated in order to verify their performance at detecting the new virus. If a low sensitivity or specificity is found, tests must be adjusted in order to improve their detection power for the new agent. There are multiple diagnostic tests, each one with its own advantages and limitations; so the selection of a test will depend on the specific conditions of a particular diagnostic laboratory.

Manuel Antonio, Vargas-Córdoba.

2010-01-01

56

INFLUENZA A H1N1 DE ORIGEN PORCINO: Métodos diagnósticos Influenza A H1N1 swine origin: diagnostic methods  

Directory of Open Access Journals (Sweden)

Full Text Available El diagnóstico de la infección por virus influenza reposa sobre técnicas virológicas directas e indirectas. Las diferentes pruebas diagnósticas poseen niveles de sensibilidad y especificidad variables que dependen en gran parte de las características genéticas y antigénicas del virus circulante. En el caso de la aparición de una nueva variante viral las pruebas disponibles en el mercado deben ser validadas para comprobar su eficiencia de detección para el nuevo virus. En caso de baja sensibilidad y especificidad, las pruebas deben ajustarse con el fin de mejorar su poder de detección del nuevo agente. Existen múltiples pruebas diagnósticas que presentan cada una sus ventajas y limitaciones y su selección dependerá de las condiciones específicas de cada laboratorio diagnóstico.The diagnosis of infection by influenza viruses relays on direct and indirect virologic techniques. Different diagnostic tests have variable sensitivities and specificities depending to a large extent on the genetic and antigenic features of the circulating virus. When a new viral variant appears, commercially available tests must be validated in order to verify their performance at detecting the new virus. If a low sensitivity or specificity is found, tests must be adjusted in order to improve their detection power for the new agent. There are multiple diagnostic tests, each one with its own advantages and limitations; so the selection of a test will depend on the specific conditions of a particular diagnostic laboratory.

Manuel Antonio Vargas-Córdoba

2010-01-01

57

The influenza pandemic preparedness planning tool InfluSim  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Planning public health responses against pandemic influenza relies on predictive models by which the impact of different intervention strategies can be evaluated. Research has to date rather focused on producing predictions for certain localities or under specific conditions, than on designing a publicly available planning tool which can be applied by public health administrations. Here, we provide such a tool which is reproducible by an explicitly formulated structure and designed to operate with an optimal combination of the competing requirements of precision, realism and generality. Results InfluSim is a deterministic compartment model based on a system of over 1,000 differential equations which extend the classic SEIR model by clinical and demographic parameters relevant for pandemic preparedness planning. It allows for producing time courses and cumulative numbers of influenza cases, outpatient visits, applied antiviral treatment doses, hospitalizations, deaths and work days lost due to sickness, all of which may be associated with economic aspects. The software is programmed in Java, operates platform independent and can be executed on regular desktop computers. Conclusion InfluSim is an online available software http://www.influsim.info which efficiently assists public health planners in designing optimal interventions against pandemic influenza. It can reproduce the infection dynamics of pandemic influenza like complex computer simulations while offering at the same time reproducibility, higher computational performance and better operability.

Duerr Hans-Peter

2007-03-01

58

Genetic diversity among pandemic 2009 influenza viruses isolated from a transmission chain  

DEFF Research Database (Denmark)

Influenza viruses such as swine-origin influenza A(H1N1) virus (A(H1N1)pdm09) generate genetic diversity due to the high error rate of their RNA polymerase, often resulting in mixed genotype populations (intra-host variants) within a single infection. This variation helps influenza to rapidly respond to selection pressures, such as those imposed by the immunological host response and antiviral therapy. We have applied deep sequencing to characterize influenza intra-host variation in a transmission chain consisting of three cases due to oseltamivir-sensitive viruses, and one derived oseltamivir-resistant case.

Fordyce, Sarah L; Bragstad, Karoline

2013-01-01

59

Spatial Transmission of 2009 Pandemic Influenza in the US.  

Science.gov (United States)

The 2009 H1N1 influenza pandemic provides a unique opportunity for detailed examination of the spatial dynamics of an emerging pathogen. In the US, the pandemic was characterized by substantial geographical heterogeneity: the 2009 spring wave was limited mainly to northeastern cities while the larger fall wave affected the whole country. Here we use finely resolved spatial and temporal influenza disease data based on electronic medical claims to explore the spread of the fall pandemic wave across 271 US cities and associated suburban areas. We document a clear spatial pattern in the timing of onset of the fall wave, starting in southeastern cities and spreading outwards over a period of three months. We use mechanistic models to tease apart the external factors associated with the timing of the fall wave arrival: differential seeding events linked to demographic factors, school opening dates, absolute humidity, prior immunity from the spring wave, spatial diffusion, and their interactions. Although the onset of the fall wave was correlated with school openings as previously reported, models including spatial spread alone resulted in better fit. The best model had a combination of the two. Absolute humidity or prior exposure during the spring wave did not improve the fit and population size only played a weak role. In conclusion, the protracted spread of pandemic influenza in fall 2009 in the US was dominated by short-distance spatial spread partially catalysed by school openings rather than long-distance transmission events. This is in contrast to the rapid hierarchical transmission patterns previously described for seasonal influenza. The findings underline the critical role that school-age children play in facilitating the geographic spread of pandemic influenza and highlight the need for further information on the movement and mixing patterns of this age group. PMID:24921923

Gog, Julia R; Ballesteros, Sébastien; Viboud, Cécile; Simonsen, Lone; Bjornstad, Ottar N; Shaman, Jeffrey; Chao, Dennis L; Khan, Farid; Grenfell, Bryan T

2014-06-01

60

Pandemic influenza and critical infrastructure dependencies: possible impact on hospitals.  

Science.gov (United States)

Hospitals will be particularly challenged when pandemic influenza spreads. Within the health sector in general, existing pandemic plans focus on health interventions to control outbreaks. The critical relationship between the health sector and other sectors is not well understood and addressed. Hospitals depend on critical infrastructure external to the organisation itself. Existing plans do not adequately consider the complexity and interdependency of systems upon which hospitals rely. The failure of one such system can trigger a failure of another, causing cascading breakdowns. Health is only one of the many systems that struggle at maximum capacity during "normal" times, as current business models operate with no or minimal "excess" staff and have become irreducible operations. This makes interconnected systems highly vulnerable to acute disruptions, such as a pandemic. Companies use continuity plans and highly regulated business continuity management to overcome process interruptions. This methodology can be applied to hospitals to minimise the impact of a pandemic. PMID:17115957

Itzwerth, Ralf L; Macintyre, C Raina; Shah, Smita; Plant, Aileen J

2006-11-20

 
 
 
 
61

Simulation model of pandemic influenza in the whole of Japan.  

Science.gov (United States)

An influenza pandemic--an outbreak of a novel influenza virus that spreads around the world--is a real threat. To predict the spread of an influenza pandemic across the whole of Japan, this study applies a real individual-based model (ribm) to the whole of Japan and simulates how a single case of influenza could spark pandemic influenza throughout Japan. We used Person-Trip (PT) data for nine regions (the Tokyo metropolitan area, Kansai, Chukyo, Fukuoka, Sendai, Sapporo, Miyazaki, Okinawa, and northern Ibaragi). PT data were collected from randomly chosen persons and contain information on their locations and their uses of all transportation modes including trains, cars, buses, bicycles, and walking. In total, the nine regions have a population of about 72 million, of whom more than 2.20 million individuals participated in the PT surveys. Estimates on the probability of movement among the nine PT regions are based on the results of the Third National Survey for Movement in 2003. Disease transmission in each region or on a train is assumed to occur within a 1-m radius. The approximate numbers of new cases arising on day 14 after the arrival of the first infected person are estimated to be 322,000 in Tokyo, 25,000 in Kansai, 4,800 in Chukyo, 3,600 in Sapporo, 2,600 in Fukuoka, 600 in Sendai, 17 in Okinawa, and 300 in Miyazaki. The disease seems to spread more slowly in smaller cities such as Miyazaki and Okinawa than in big cities such as Tokyo and Kansai. Area quarantines may help to contain outbreaks in smaller cities, but probably not in larger cities. Because this study demonstrates that ribm is useful for simulating the spread of pandemic influenza in Japan, it is hoped that this modeling technique will be used in the creation of preparedness plans. PMID:19305048

Ohkusa, Yasushi; Sugawara, Tamie

2009-03-01

62

Conceptional considerations for a German influenza pandemic preparedness plan.  

Science.gov (United States)

A pandemic appearance of influenza A virus must be expected at any time. The limitations of health preserving and life-saving resources, which will inevitably be reached in the event of a pandemic, will be accompanied by ethical and possibly social conflicts, which can be lessened or resolved only through precautionary planning, clearly specified competencies and transparent decisions within a social consensus. In case of a shortage of vaccines and virostatic agents, decisions will have to be made with regard to the segment of the population that absolutely must be vaccinated. It is currently estimated that a (monovalent) vaccine developed for a new pandemic strain would only suffice for the single vaccination of approximately half of the German population after a year; only 10-14 million vaccine dosages would be available to provide basic immunization and single boosters to personnel required to maintain basic medical care and essential infrastructure after half a year. In the event of local influenza outbreaks, antiviral chemotherapeutic agents could be used to close the gap until a vaccine can become effective. Even if suitable influenza vaccines and virostatic agents are not sufficiently available at the start of a pandemic, it is still possible to at least prevent an outbreak of two of the most feared secondary infections that accompany influenza: pneumococcal pneumonia or meningitis and illnesses resulting from Haemophilus influenzae. Agreement still needs to be reached with manufacturers for guaranteeing the necessary vaccine production or ensuring that they have a sufficient stock to meet the minimum demand for antiviral agents and agents for symptomatic treatment. PMID:12458359

Fock, R; Bergmann, H; Bussmann, H; Fell, G; Finke, E-J; Koch, U; Niedrig, M; Peters, M; Scholz, D; Wirtz, A

2002-12-01

63

Antiviral prophylaxis during pandemic influenza may increase drug resistance  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Abstract Background Neuraminidase inhibitors (NI) and social distancing play a major role in plans to mitigate future influenza pandemics. Methods Using the freely available program InfluSim, the authors examine to what extent NI-treatment and prophylaxis promote the occurrence and transmission of a NI resistant strain. Results Under a basic reproduction number of R0 = 2.5, a NI resistant strain can only spread if its transmissi...

Koch Daniel; Witschi Mark; Duerr Hans-Peter; Schwehm Markus; Eichner Martin; Brockmann Stefan O; Vidondo Beatriz

2009-01-01

64

Pediatric Healthcare Response to Pandemic (H1N1) 2009 Influenza Stakeholder Meeting - Summary of Proceedings  

Energy Technology Data Exchange (ETDEWEB)

The goal of the meeting was to bring together subject matter experts to develop tools and resources for use by the pediatric healthcare community in response to 2009 (H1N1) pandemic influenza activity during the 2009 influenza season.

HCTT CHE

2010-01-01

65

Community Assessment Tool for Public Health Emergencies Including Pandemic Influenza  

Energy Technology Data Exchange (ETDEWEB)

The Community Assessment Tool (CAT) for Public Health Emergencies Including Pandemic Influenza (hereafter referred to as the CAT) was developed as a result of feedback received from several communities. These communities participated in workshops focused on influenza pandemic planning and response. The 2008 through 2011 workshops were sponsored by the Centers for Disease Control and Prevention (CDC). Feedback during those workshops indicated the need for a tool that a community can use to assess its readiness for a disaster - readiness from a total healthcare perspective, not just hospitals, but the whole healthcare system. The CAT intends to do just that - help strengthen existing preparedness plans by allowing the healthcare system and other agencies to work together during an influenza pandemic. It helps reveal each core agency partners (sectors) capabilities and resources, and highlights cases of the same vendors being used for resource supplies (e.g., personal protective equipment [PPE] and oxygen) by the partners (e.g., public health departments, clinics, or hospitals). The CAT also addresses gaps in the community's capabilities or potential shortages in resources. This tool has been reviewed by a variety of key subject matter experts from federal, state, and local agencies and organizations. It also has been piloted with various communities that consist of different population sizes, to include large urban to small rural communities.

ORAU' s Oak Ridge Institute for Science Education (HCTT-CHE)

2011-04-14

66

Two resource distribution strategies for dynamic mitigation of influenza pandemics  

Directory of Open Access Journals (Sweden)

Full Text Available Andrés Uribe-Sánchez, Alex Savachkin1Department of Industrial and Management Systems Engineering University of South Florida, Tampa, FL 33620, USAAbstract: As recently pointed out by the Institute of Medicine, the existing pandemic ­containment and mitigation models lack the dynamic decision support capabilities. We ­present two simulation-based optimization models for developing dynamic predictive resource ­distribution strategies for cross-regional pandemic outbreaks. In both models, the underlying simulation mimics the disease and population dynamics of the affected regions. The quantity-based optimization model generates a progressive allocation of limited quantities of mitigation resources, including vaccines, antiviral, administration capacities, and social distancing enforcement resources. The budget-based optimization model strives instead allocating a total resource budget. Both models seek to minimize the impact of ongoing outbreaks and the expected impact of potential outbreaks. The models incorporate measures of morbidity, mortality, and social distancing, translated into the societal and economic costs of lost productivity and medical expenses. The models were calibrated using historic pandemic data and implemented on a sample outbreak in Florida, with over four million inhabitants. The quantity-based model was found to be inferior to the budget-based model, which was advantageous in its ability to balance the varying relative cost and effectiveness of individual resources. The models are intended to assist public health policy makers in developing effective distribution policies for mitigation of influenza pandemics.Keywords: pandemic, mitigation, distribution, dynamic, resources, budget

Andrés Uribe-Sánchez

2010-07-01

67

The Highly Pathogenic Avian Influenza H5N1 – Initial Molecular Signals for the Next Influenza Pandemic  

Directory of Open Access Journals (Sweden)

Full Text Available A new pandemic influenza in the human world may originate from avian reservoirs.Influenza is one of the most widely spread zoonotic infectious diseases. All avian influenzaviruses are type A, and they have often caused pandemics throughout human history. Thehighly pathogenic H5N1 influenza A viruses have now been spreading to many countries inAsia, Europe and Africa. They have infected an increasing number of humans in at least 15countries in the world. This paper describes recent advances in the mechanism of transmissionof highly pathogenic avian influenza to humans and measures for control of a new pandemic.

Yasuo Suzuki

2009-06-01

68

Seasonal influenza vaccination and the risk of infection with pandemic influenza: a possible illustration of non-specific temporary immunity following infection.  

Science.gov (United States)

Four Canadian studies have suggested that receipt of seasonal influenza vaccine increased the risk of laboratory-confirmed infection with 2009 pandemic influenza A(H1N1). During the influenza season of 2009 in Victoria, Australia, this virus comprised 97% of all circulating influenza viruses for which sub-typing was available. We found no evidence that seasonal influenza vaccine increased the risk of, or provided protection against, infection with the pandemic virus. Ferret experiments have suggested protection against pandemic influenza A(H1N1) 2009 from multiple prior seasonal influenza infections but not from prior seasonal vaccination. Modelling studies suggest that influenza infection leads to heterosubtypic temporary immunity which is initially almost complete. We suggest these observations together can explain the apparent discrepant findings in Canada and Victoria. In Victoria there was no recent prior circulation of seasonal influenza and thus no temporary immunity to pandemic influenza. There was no association of seasonal influenza vaccine with pandemic influenza infection. In Canada seasonal influenza preceded circulation of the pandemic virus. An unvaccinated proportion of the population developed temporary immunity to pandemic influenza from seasonal infection but a proportion of vaccinated members of the population did not get seasonal infection and hence did not develop temporary immunity to pandemic influenza. It may therefore have appeared as if seasonal vaccination increased the risk of infection with pandemic influenza A(H1N1) virus. PMID:21144441

Kelly, H; Barry, S; Laurie, K; Mercer, G

2010-11-25

69

Pandemic influenza A (H1N1) 2009: the experience of the first six months.  

Science.gov (United States)

After a break of 41 years, 2009 saw the first influenza pandemic of the 21st century caused by a triple-reassortant influenza A (H1N1) virus. The current estimated case fatality rate is lower than that of previous influenza pandemics, but this may change as the pandemic evolves. Illness frequently occurs in previously healthy, young adults with a wide range of clinical presentations. The majority of circulating pandemic viruses remain susceptible to neuraminidase inhibitors, although all strains are intrinsically resistant to the adamantanes. Monovalent vaccines against the pandemic strain are available in both live attenuated and inactivated forms. This review aims to summarise important virological, epidemiological and clinical aspects of the pandemic influenza A (H1N1) virus for physicians and other clinical personnel. PMID:20025556

Maritz, Jean; Maree, Leana; Preiser, Wolfgang

2010-01-01

70

The first influenza pandemic of the 21st century  

Directory of Open Access Journals (Sweden)

Full Text Available The 2009 H1N1 influenza virus (formerly known as swine flu first appeared in Mexico and the United States in March and April 2009 and has swept the globe with unprecedented speed as a result of airline travel. On June 11, 2009, the World Health Organization raised its pandemic level to the highest level, Phase 6, indicating widespread community transmission on at least two continents. The 2009 H1N1 virus contains a unique combination of gene segments from human, swine and avian influenza A viruses. Children and young adults appear to be the most affected, perhaps reflecting protection in the elderly owing to exposure to H1N1 strains before 1957. Most clinical disease is relatively mild but complications leading to hospitalization, with the need for intensive care, can occur, especially in very young children, during pregnancy, in morbid obesity, and in those with underlying medical conditions such as chronic lung and cardiac diseases, diabetes, and immunosuppression. Bacterial co-infection has played a significant role in fatal cases. The case of fatality has been estimated at around 0.4%. Mathematical modeling suggests that the effect of novel influenza virus can be reduced by immunization, but the question remains: can we produce enough H1N1 vaccine to beat the pandemic?

Al Hajjar Sami

2010-01-01

71

The pandemic (H1N1) 2009 influenza virus is resistant to mannose-binding lectin  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Abstract Background Mannose-binding lectin (MBL) is an important component of innate immunity because it promotes bacterial clearance and neutralization of human influenza A viruses. Since a majority of humans have no neutralizing antibody against the pandemic (H1N1) 2009 influenza (pandemic 2009) virus, innate immunity may be crucial and MBL susceptibility may therefore influence viral pathogenesis. Results We examined MBL susceptibility of influenza A viruses ...

Ushirogawa Hiroshi; Tokunaga Hirotoshi; Ohuchi Masanobu

2011-01-01

72

Rol de la Nefrología en la pandemia por Influenza A (H1N1): Puesta al día / The role of nephrology in the influenza A (H1N1) pandemic update  

Scientific Electronic Library Online (English)

Full Text Available SciELO Spain | Language: Spanish Abstract in spanish En junio de 2009, la OMS declaró la pandemia por virus de la influenza A de origen porcino (H1N1). Desde entonces, los nefrólogos fuimos afectados en varias de nuestras actividades. Disminuyó la asistencia al trabajo del personal de salud al cuidado de pacientes renales crónicos. Aparecieron nuevos [...] casos de fallo renal agudo asociados a la infección viral, la mayoría en adultos jóvenes, con alta tasa de mortalidad. Hubo contagios en pacientes trasplantados renales y se retrajo transitoriamente la procuración de órganos en la semanas de mayor contagio. Entidades científicas se movilizaron para consensuar protocolos de evaluación y tratamiento con el fin de disminuir el impacto de la pandemia en pacientes renales. Abstract in english In June 2009, WHO declared pandemic swine origin influenza A virus (H1N1). Since then, nephrologists were involved in several of our activities. Decreased work attendance of healthcare for chronic renal patients. Appeared new cases of acute renal failure associated with viral infection, mostly in yo [...] ung adults, with high mortality rate. There were infections in renal transplant patients and temporarily decreased the organs procurement in the weeks of further spread. Scientific institutions were mobilized to agree on protocols for assessment and treatment in order to lessen the impact of the pandemic in renal patients.

A., Vallejos.

73

Response to the 2009 influenza A(H1N1) pandemic in Italy.  

Science.gov (United States)

In Italy, the arrival of the 2009 pandemic influenza A(H1N1) virus triggered an integrated response that was mainly based on the 2006 National Pandemic Preparedness and Response Plan. In this article we analyse the main activities implemented for epidemiological surveillance, containment and mitigation of the pandemic influenza and the lesson learned from this experience. Overall, from week 31 (27 July – 2 August) of 2009 to week 17 (26 April – 2 May) of 2010, we estimate that there were approximately 5,600,000 cases of influenza-like illness (ILI) who received medical attention (with almost 2,000 laboratory-confirmed cases of pandemic influenza from May to October 2009). A total of 1,106 confirmed cases were admitted to hospital for serious conditions, of whom 532 were admitted to intensive care units. There were 260 reported deaths due to pandemic influenza. Approximately 870,000 first doses of the pandemic vaccine were administered, representing a vaccine coverage of 4% of the target population. One of the possible reasons for the low uptake of the pandemic vaccine in the target population could be the communication strategy adopted, for both the general population and healthcare workers, which turned out to be a major challenge. Active involvement of all health professionals (at local, regional and national level) in influenza pandemic preparedness and response should be encouraged in the future. PMID:21163178

Rizzo, C; Rota, M C; Bella, A; Giannitelli, S; De Santis, S; Nacca, G; Pompa, M G; Vellucci, L; Salmaso, S; Declich, S

2010-12-01

74

Pandemic (H1N1 influenza in Diyarbakir, 2009  

Directory of Open Access Journals (Sweden)

Full Text Available  Objective: This study was conducted to evaluate the pandemic (H1N1 influenza outbreak in 2009. Method: Influenza like illness (ILI cases were reported between the 36th to 53rd weeks of the pandemic, from all health centres. 731 nasopharyngeal swabs were collected from ILI cases. Results: The first H1N1 confirmed case was reported at the 36th week and an increasing trend continued. At the 43rd week the outbreak reached its maximum level and at the 53rd week the level had decreased to the level at the start. During the outbreak 31117 cases were reported as ILI and 635 cases were hospitalized (hospitalization rate was 2.0% and 17 H1N1 laboratory confirmed cases died (mortality rate 11.5/1.000.000. Symptoms of laboratory confirmed cases were similar to seasonal influenza. Coughing (90.9%, fever (84.5%, running nose (69.5%, headache (73.4%, diarrhoea (17.5% were the some of the symptoms in laboratory confirmed cases. The median interval between the onset of symptoms and hospital admission was 3.5 days (min: 1, max: 11 days and this was 7.5 days for the occurrence of death. Conclusion: During 36th to 53rd week an important outbreak of ILI was occurred. The mortality rate was not so high as expected but the infectivity was high. The delay for hospital admission may lead to higher mortality particularly for pregnant women.Key Words: Pandemic influenza; H1N1; case fatality rate; hospitalization rateDiyarbak?r’da pandemik (H1N1 influenza, 2009Amaç: Bu çal??mada 2009 y?l?nda -Türkiye’de pandemik influenza salg?n?n? de?erlendirmek amaçlanm??t?r. Yöntem: Diyarbak?r ’da 36 ve 53. haftalar aras?nda tüm sa?l?k kurulu?lar?ndan influenza benzeri hastal?k rapor edilmi?tir. 731 nazofaringeal sürüntü al?nm??t?r. Bulgular: ?lk H1N1 do?rulanm?? vaka 36.haftada rapor edilmi?tir ve vaka say?lar? zaman içinde art?? göstermi?tir. 43. haftada salg?n ba?lam?? ve 53. haftada ba?lang?ç düzeyine inmi?tir.Salg?n s?ras?nda 31117 vaka grip benzeri hastal?k olarak raporlanm??, 635 vaka hastaneye yatm?? (hastaneye yat?? h?z? %2.0 ve laboratuvar olarak do?rulanm?? 17 vaka ölmü?tür (ölüm h?z? milyonda 11.5. Laboratuvar olarak do?rulanm?? vakalar?n semptomlar? mevsimsel influenza ile benzerlik  göstermi?tir. Laboratuvar olarak do?rulanm?? vakalar?n baz? semptomlar? öksürük (%90.9, ate? (%84.5, burun ak?nt?s? (%69.5, ba? a?r?s? (%73.4 ve ishal (%17.5 olmu?tur. Semptomlar?n ba?lamas? ile hastaneye ba?vuru suresi ortancas? 3.5 gün (en az:1, en çok:11 gün, ölüm süresi ortancas? ise 7.5 gündür. Sonuç: Diyarbak?r’da 36 ve 53. haftalar aras?nda önemli bir grip benzeri hastal?k salg?n? ya?anm??t?r. Mortalite h?z? beklenildi?i kadar fazla olmamakla birlikte, bula?t?r?c?l?k h?z? yüksektir. Hastane ba?vurular?ndaki gecikme özellikle gebe kad?nlarda ölüme yol açm?? olabilir. Anahtar Kelimeler: Pandemik influenza; H1N1, vaka ölüm h?z?, hastaneye yatma h?z?

Meliksah Ertem

2011-09-01

75

Knowledge about pandemic influenza and compliance with containment measures among Australians  

Science.gov (United States)

Abstract Objective To examine the level of stated compliance with public health pandemic influenza control measures and explore factors influencing cooperation for pandemic influenza control in Australia. Methods A computer-assisted telephone interview survey was conducted by professional interviewers to collect information on the Australian public’s knowledge of pandemic influenza and willingness to comply with public health control measures. The sample was randomly selected using an electronic database and printed telephone directories to ensure sample representativeness from all Australian states and territories. After we described pandemic influenza to the respondents to ensure they understood the significance of the issue, the questions on compliance were repeated and changes in responses were analysed with McNemar’s test for paired data. Findings Only 23% of the 1166 respondents demonstrated a clear understanding of the term “pandemic influenza”. Of those interviewed, 94.1% reported being willing to comply with home quarantine; 94.2%, to avoid public events; and 90.7%, to postpone social gatherings. After we explained the meaning of “pandemic” to interviewees, stated compliance increased significantly (to 97.5%, 98.3% and 97.2% respectively). Those who reported being unfamiliar with the term “pandemic influenza,” male respondents and employed people not able to work from home were less willing to comply. Conclusion In Australia, should the threat arise, compliance with containment measures against pandemic influenza is likely to be high, yet it could be further enhanced through a public education programme conveying just a few key messages. A basic understanding of pandemic influenza is associated with stated willingness to comply with containment measures. Investing now in promoting measures to prepare for a pandemic or other health emergency will have considerable value. PMID:19705008

Durrheim, David; Francis, J Lynn; d'Espaignet, Edouard Tursan; Duncan, Sarah; Islam, Fakhrul; Speare, Rick

2009-01-01

76

Behavioural intentions in response to an influenza pandemic  

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Full Text Available Abstract Background Little is known regarding which behavioural responses can be expected if an influenza pandemic were to occur. Methods A survey comprising questions based on risk perception theories, in particular PMT, was conducted with a Dutch sample. Results Although fear that an influenza pandemic may occur was high, participants do not feel well informed. General practitioners and local health authorities were considered trustworthy sources of information and the information considered most urgent pertained to which protective measures should be taken. Participants reported an intention to comply with recommendations regarding protective measures. However, response and self efficacy were low. Maladaptive behaviours can be expected. Increasing numbers of ill individuals and school closures are also expected to lead to a decreased work force. Participants indicated wanting antiviral drugs even if the supply were to be insufficient. Conclusions Messages regarding health protective behaviours from local health authorities should anticipate the balance between overreacting and underreacting. Also, when protective recommendations from health professionals conflict with company policies, it is unclear how employees will react.

Schaalma Herman

2010-03-01

77

Antiviral prophylaxis during pandemic influenza may increase drug resistance  

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Full Text Available Abstract Background Neuraminidase inhibitors (NI and social distancing play a major role in plans to mitigate future influenza pandemics. Methods Using the freely available program InfluSim, the authors examine to what extent NI-treatment and prophylaxis promote the occurrence and transmission of a NI resistant strain. Results Under a basic reproduction number of R0 = 2.5, a NI resistant strain can only spread if its transmissibility (fitness is at least 40% of the fitness of the drug-sensitive strain. Although NI drug resistance may emerge in treated patients in such a late state of their disease that passing on the newly developed resistant viruses is unlikely, resistant strains quickly become highly prevalent in the population if their fitness is high. Antiviral prophylaxis further increases the pressure on the drug-sensitive strain and favors the spread of resistant infections. The authors show scenarios where pre-exposure antiviral prophylaxis even increases the number of influenza cases and deaths. Conclusion If the fitness of a NI resistant pandemic strain is high, any use of prophylaxis may increase the number of hospitalizations and deaths in the population. The use of neuraminidase inhibitors should be restricted to the treatment of cases whereas prophylaxis should be reduced to an absolute minimum in that case.

Koch Daniel

2009-01-01

78

Comparison of Pandemic (H1N1) 2009 and Seasonal Influenza, Western Australia, 2009  

Science.gov (United States)

We compared confirmed pandemic (H1N1) 2009 influenza and seasonal influenza diagnosed in Western Australia during the 2009 influenza season. From 3,178 eligible reports, 984 pandemic and 356 seasonal influenza patients were selected; 871 (88.5%) and 288 (80.9%) were interviewed, respectively. Patients in both groups reported a median of 6 of 11 symptoms; the difference between groups in the proportion reporting any given symptom was 1 underlying condition, and only diabetes was associated with pandemic (H1N1) 2009 influenza (odds ratio [OR] 1.9, 95% confidence interval [CI] 1.1–3.5). A total of 129 (14.8%) persons with pandemic (H1N1) 2009 and 36 (12.5%) persons with seasonal influenza were hospitalized (p = 0.22). After controlling for age, we found that patient hospitalization was associated with pandemic (H1N1) 2009 influenza (OR 1.5; 95% CI 1.1–2.1). Contemporaneous pandemic and seasonal influenza infections were substantially similar in terms of patients’ symptoms, risk factors, and proportion hospitalized. PMID:20735922

Carcione, Dale; Giele, Carolien; Dowse, Gary K.; Mak, Donna B.; Goggin, Leigh; Kwan, Kelly; Williams, Simon; Smith, David

2010-01-01

79

Pandemia de influenza: la respuesta de México / Influenza pandemic: Mexico's response  

Scientific Electronic Library Online (English)

Full Text Available SciELO Mexico | Language: Spanish Abstract in spanish En 1992 apareció en el sureste asiático un nuevo tipo de virus de la influenza, el cual ha ocasionado hasta la fecha más de 120 casos y un poco más de 60 defunciones en humanos en Camboya, Vietnam, Indonesia y Tailandia. Esta situación es considerada por los expertos como la probable génesis de una [...] nueva pandemia de influenza, lo que podría traer graves consecuencias para la salud de la población, así como para la economía y el comercio mundial. Por lo anterior, la Organización Mundial de la Salud (OMS) ha instado a los países miembros a desarrollar planes de preparación y respuesta para hacer frente a esta eventualidad. En el marco del Comité Nacional para la Seguridad en Salud, México ha diseñado el Plan Nacional de Preparación y Respuesta ante una Pandemia de Influenza con objeto de proteger a la población mediante acciones efectivas y oportunas. El Plan utiliza una escala de riesgo y define cinco líneas de acción: Coordinación, Vigilancia Epidemiológica, Atención Médica, Difusión y Movilización Social, y Reserva Estratégica. Si bien es imposible predecir cuándo se presentará la próxima pandemia y su impacto, es fundamental que las autoridades de salud nacionales, estatales y locales establezcan los mecanismos para poner en marcha los componentes del Plan en forma oportuna y garantizar con ello la salud de la población en caso de influenza pandémica. Abstract in english In 1992, a new type of influenza virus appeared in Southeast Asia. This new strain has caused to date, more than 120 cases and over 60 deaths in Cambodia, Vietnam, Indonesia and Thailand. This situation is seen by the experts as the possible genesis of a new influenza pandemic with the corresponding [...] negative effects on the health of the population, international commerce and world economy. In order to face the coming challenge, the World Health Organization (WHO) has asked member countries to develop national preparedness and response plans for an influenza pandemic. Within the framework of the National Committee for Health Security, Mexico has developed a National Preparedness and Response Plan for an Influenza Pandemic with the aim of protecting the health of the population with timely and effective measures. The Plan is based on a risk scale and five lines of action: Coordination, Epidemiological Surveillance, Medical Care, Risk Communication and Strategic Stockpile. It is currently impossible to predict when the next pandemic will start or what will be its impact. Nevertheless, it is fundamental that national and regional health authorities establish measures for protecting the health of the population in case this emergency occurs.

Pablo, Kuri-Morales; Miguel, Betancourt-Cravioto; Oscar, Velázquez-Monroy; Carlos, Alvarez-Lucas; Roberto, Tapia-Conyer.

2006-02-01

80

Pandemia de influenza: la respuesta de México / Influenza pandemic: Mexico's response  

Scientific Electronic Library Online (English)

Full Text Available SciELO Public Health | Language: Spanish Abstract in spanish En 1992 apareció en el sureste asiático un nuevo tipo de virus de la influenza, el cual ha ocasionado hasta la fecha más de 120 casos y un poco más de 60 defunciones en humanos en Camboya, Vietnam, Indonesia y Tailandia. Esta situación es considerada por los expertos como la probable génesis de una [...] nueva pandemia de influenza, lo que podría traer graves consecuencias para la salud de la población, así como para la economía y el comercio mundial. Por lo anterior, la Organización Mundial de la Salud (OMS) ha instado a los países miembros a desarrollar planes de preparación y respuesta para hacer frente a esta eventualidad. En el marco del Comité Nacional para la Seguridad en Salud, México ha diseñado el Plan Nacional de Preparación y Respuesta ante una Pandemia de Influenza con objeto de proteger a la población mediante acciones efectivas y oportunas. El Plan utiliza una escala de riesgo y define cinco líneas de acción: Coordinación, Vigilancia Epidemiológica, Atención Médica, Difusión y Movilización Social, y Reserva Estratégica. Si bien es imposible predecir cuándo se presentará la próxima pandemia y su impacto, es fundamental que las autoridades de salud nacionales, estatales y locales establezcan los mecanismos para poner en marcha los componentes del Plan en forma oportuna y garantizar con ello la salud de la población en caso de influenza pandémica. Abstract in english In 1992, a new type of influenza virus appeared in Southeast Asia. This new strain has caused to date, more than 120 cases and over 60 deaths in Cambodia, Vietnam, Indonesia and Thailand. This situation is seen by the experts as the possible genesis of a new influenza pandemic with the corresponding [...] negative effects on the health of the population, international commerce and world economy. In order to face the coming challenge, the World Health Organization (WHO) has asked member countries to develop national preparedness and response plans for an influenza pandemic. Within the framework of the National Committee for Health Security, Mexico has developed a National Preparedness and Response Plan for an Influenza Pandemic with the aim of protecting the health of the population with timely and effective measures. The Plan is based on a risk scale and five lines of action: Coordination, Epidemiological Surveillance, Medical Care, Risk Communication and Strategic Stockpile. It is currently impossible to predict when the next pandemic will start or what will be its impact. Nevertheless, it is fundamental that national and regional health authorities establish measures for protecting the health of the population in case this emergency occurs.

Pablo, Kuri-Morales; Miguel, Betancourt-Cravioto; Oscar, Velázquez-Monroy; Carlos, Alvarez-Lucas; Roberto, Tapia-Conyer.

2006-02-01

 
 
 
 
81

Pandemia de influenza: la respuesta de México Influenza pandemic: Mexico's response  

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Full Text Available En 1992 apareció en el sureste asiático un nuevo tipo de virus de la influenza, el cual ha ocasionado hasta la fecha más de 120 casos y un poco más de 60 defunciones en humanos en Camboya, Vietnam, Indonesia y Tailandia. Esta situación es considerada por los expertos como la probable génesis de una nueva pandemia de influenza, lo que podría traer graves consecuencias para la salud de la población, así como para la economía y el comercio mundial. Por lo anterior, la Organización Mundial de la Salud (OMS ha instado a los países miembros a desarrollar planes de preparación y respuesta para hacer frente a esta eventualidad. En el marco del Comité Nacional para la Seguridad en Salud, México ha diseñado el Plan Nacional de Preparación y Respuesta ante una Pandemia de Influenza con objeto de proteger a la población mediante acciones efectivas y oportunas. El Plan utiliza una escala de riesgo y define cinco líneas de acción: Coordinación, Vigilancia Epidemiológica, Atención Médica, Difusión y Movilización Social, y Reserva Estratégica. Si bien es imposible predecir cuándo se presentará la próxima pandemia y su impacto, es fundamental que las autoridades de salud nacionales, estatales y locales establezcan los mecanismos para poner en marcha los componentes del Plan en forma oportuna y garantizar con ello la salud de la población en caso de influenza pandémica.In 1992, a new type of influenza virus appeared in Southeast Asia. This new strain has caused to date, more than 120 cases and over 60 deaths in Cambodia, Vietnam, Indonesia and Thailand. This situation is seen by the experts as the possible genesis of a new influenza pandemic with the corresponding negative effects on the health of the population, international commerce and world economy. In order to face the coming challenge, the World Health Organization (WHO has asked member countries to develop national preparedness and response plans for an influenza pandemic. Within the framework of the National Committee for Health Security, Mexico has developed a National Preparedness and Response Plan for an Influenza Pandemic with the aim of protecting the health of the population with timely and effective measures. The Plan is based on a risk scale and five lines of action: Coordination, Epidemiological Surveillance, Medical Care, Risk Communication and Strategic Stockpile. It is currently impossible to predict when the next pandemic will start or what will be its impact. Nevertheless, it is fundamental that national and regional health authorities establish measures for protecting the health of the population in case this emergency occurs.

Pablo Kuri-Morales

2006-02-01

82

Simulating the Spread of Influenza Pandemic of 1918-1919 Considering the Effect of the First World War  

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The Influenza Pandemic of 1918-1919, also called Spanish Flu Pandemic, was one of the severest pandemics in history. It is thought that the First World War much influenced the spread of the pandemic. In this paper, we model the pandemic considering both civil and military traffic. We propose a hybrid model to determine how the pandemic spread through the world. Our approach considers both the SEIR-based model for local areas and the network model for global connection betwee...

Yoneyama, Teruhiko; Krishnamoorthy, Mukkai S.

2010-01-01

83

Pandemic influenza in Papua New Guinea: a modelling study comparison with pandemic spread in a developed country  

Science.gov (United States)

Objectives The possible occurrence of a highly pathogenic influenza strain is of concern to health authorities worldwide. It is known that during past influenza pandemics developing countries have experienced considerably higher death rates compared with developed countries. Furthermore, many developing countries lack appropriate pandemic preparedness plans. Mathematical modelling studies to guide the development of such plans are largely focused on predicting pandemic influenza spread in developed nations. However, intervention strategies shown by modelling studies to be highly effective for developed countries give limited guidance as to the impact which an influenza pandemic may have on low-income countries given different demographics and resource constraints. To address this, an individual-based model of a Papua New Guinean (PNG) community was created and used to simulate the spread of a novel influenza strain. The results were compared with those obtained from a comparable Australian model. Design A modelling study. Setting The towns of Madang in PNG (population ?35?000) and Albany (population ?30?000) in Australia. Outcome measures Daily and cumulative illness attack rates in both models following introduction of a novel influenza strain into a naive population, for an unmitigated scenario and two social distancing intervention scenarios. Results The unmitigated scenario indicated an approximately 50% higher attack rate in PNG compared with the Australian model. The two social distancing-based interventions strategies were 60–70% less effective in a PNG setting compared with an Australian setting. Conclusions This study provides further evidence that an influenza pandemic occurring in a low-income country such as PNG may have a greater impact than one occurring in a developed country, and that PNG-feasible interventions may be substantially less effective. The larger average household size in PNG, the larger proportion of the population under 18 and greater community-wide contact all contribute to this feature. PMID:23535701

Milne, George J; Baskaran, Pravin; Halder, Nilimesh; Karl, Stephan; Kelso, Joel

2013-01-01

84

Simulation to assess the efficacy of US airport entry scrreening of passengers for pandemic influenza  

Energy Technology Data Exchange (ETDEWEB)

We present our methodology and stochastic discrete-event simulation developed to model the screening of passengers for pandemic influenza at the US port-of-entry airports. Our model uniquely combines epidemiology modelling, evolving infected states and conditions of passengers over time, and operational considerations of screening in a single simulation. The simulation begins with international aircraft arrivals to the US. Passengers are then randomly assigned to one of three states -- not infected, infected with pandemic influenza and infected with other respiratory illness. Passengers then pass through various screening layers (i.e. pre-departure screening, en route screening, primary screening and secondary screening) and ultimately exit the system. We track the status of each passenger over time, with a special emphasis on false negatives (i.e. passengers infected with pandemic influenza, but are not identified as such) as these passengers pose a significant threat as they could unknowingly spread the pandemic influenza virus throughout our nation.

Mcmahon, Benjamin [Los Alamos National Laboratory

2009-01-01

85

Estrategia cubana de caracterización molecular del virus influenza A/H1N1pdm / Cuban strategy for the molecular characterization of the pandemic influenza A virus (H1N1)  

Scientific Electronic Library Online (English)

Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish INTRODUCCIÓN: en Abril de 2009 se identificó una variante del virus influenza A/H1N1 de origen porcino, lo cual determinó que fuese declarada rápidamente la primera pandemia del siglo XXI. OBJETIVO: establecer una estrategia de secuenciación nucleotídica que permitiera diagnosticar diferencialmente [...] los virus influenza A estacionales del nuevo virus pandémico, así como obtener la mayor cantidad de información posible desde el punto de vista molecular de los genes hemaglutinina y neuraminidasa, tanto de pacientes que sufrieron una enfermedad tipo influenza como los que padecieron de una infección respiratoria aguda grave y los que fallecieron. MÉTODOS: se diseñaron e implementaron tres estrategias de secuenciación que brindaron información importante acerca del nuevo virus en Cuba. RESULTADOS: a través de la tercera estrategia se obtuvieron los resultados más completos: diagnóstico diferencial, vigilancia de las mutaciones D222G/E en la hemaglutinina y las variantes virales H275Y resistentes al Tamiflu. A pesar de no haber detectado las mutaciones mencionadas, no se puede descartar su presencia en población cubana, debido a que estas estrategias no fueron diseñadas con ese fin. Se impone diseñar un estudio para cumplir con ese objetivo. CONCLUSIONES: las estrategias de secuenciación aplicadas en nuestro algoritmo permitieron realizar el diagnóstico diferencial de los virus influenza estacional del pandémico y su caracterización molecular. Abstract in english INTRODUCTION: in April 2009, there was identified a variant of the A/H1N1 influenza virus of swine origin, and shortly after the first pandemic in XXI century was declared. OBJECTIVES: to establish a nucleotide sequencing strategy for the differential diagnosis of the seasonal and pandemic influenza [...] A viruses, and to obtain as much molecular information as possible about hemagglutinin and neuraminidase genes in patients with influenza-like illnesses, in those with severe respiratory infection and in patients who died. METHODS: three sequencing strategies were designed and implemented, which also offered important information about the new virus in Cuba. RESULTS: the third strategy provided the most comprehensive results such as differential diagnosis, the surveillance of the D222G/E mutation in hemagglutinin and Tamiflu-resistant H275Y viral variants. In spite of the fact that the mentioned mutations were not detected, their presence in the Cuban population can not be ignored since these strategies were not designed for this end. It is imperative to design a study to fulfill this objective. CONCLUSIONS: the sequencing strategies in our algorithm allowed the differential diagnosis of the seasonal and the pandemic viruses, and their molecular characterization.

Alexander, Piñón Ramos; Belsy, Acosta Herrera; Odalys, Valdés Ramírez; Amely, Arencibia García; Clara Estela, Savón Valdés; Grehete, González Muñoz; Suset Isabel, Oropesa Fernández; Elías, Quilarte García; Guelsys, González Baez; Bárbara, Hernández Espinosa; Ángel, Goyenechea Hernández; María Guadalupe, Guzmán Tirado; Alina, Llop Hernández; Vivian, Kourí Cardellá.

2011-04-01

86

Influenza pandemic and professional duty: family or patients first? A survey of hospital employees  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Abstract Background Conflicts between professional duties and fear of influenza transmission to family members may arise among health care professionals (HCP). Methods We surveyed employees at our university hospital regarding ethical issues arising during the management of an influenza pandemic. Results Of 644 respondents, 182 (28%) agreed that it would be professionally acceptable for HCP to abandon their workplace during a pandemic in order to p...

2006-01-01

87

Local public health workers' perceptions toward responding to an influenza pandemic  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Abstract Background Current national preparedness plans require local health departments to play an integral role in responding to an influenza pandemic, a major public health threat that the World Health Organization has described as "inevitable and possibly imminent". To understand local public health workers' perceptions toward pandemic influenza response, we surveyed 308 employees at three health departments in Maryland from March – July 2005, on factors that may influe...

Everly George S; Barnett Daniel J; Omer Saad B; Balicer Ran D

2006-01-01

88

Emergency Department Visits for Antiviral Adverse Events During the 2009 H1N1 Influenza Pandemic  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The 2009 pandemic influenza A (H1N1) outbreak was associated with an increased use of antiviral agents and highlighted the role of population-based monitoring for related adverse drug events (ADEs). An ongoing, nationally representative emergency department-based surveillance system was used to identify and characterize ADEs during the pandemic. Active surveillance for ADEs successfully provided timely, population-based data during the pandemic. Increases in antiviral ADEs paralleled increase...

Lovegrove, Maribeth C.; Shehab, Nadine; Hales, Craig M.; Poneleit, Kathy; Crane, Elizabeth; Budnitz, Daniel S.

2011-01-01

89

Antiviral resistance during pandemic influenza: implications for stockpiling and drug use  

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Abstract Background The anticipated extent of antiviral use during an influenza pandemic can have adverse consequences for the development of drug resistance and rationing of limited stockpiles. The strategic use of drugs is therefore a major public health concern in planning for effective pandemic responses. Methods We employed a mathematical model that includes both sensitive and resistant strains of a virus with pandemic potential, and applies antiviral drugs...

2009-01-01

90

Statistical estimates of absenteeism attributable to seasonal and pandemic influenza from the Canadian Labour Force Survey  

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Full Text Available Abstract Background As many respiratory viruses are responsible for influenza like symptoms, accurate measures of the disease burden are not available and estimates are generally based on statistical methods. The objective of this study was to estimate absenteeism rates and hours lost due to seasonal influenza and compare these estimates with estimates of absenteeism attributable to the two H1N1 pandemic waves that occurred in 2009. Methods Key absenteeism variables were extracted from Statistics Canada's monthly labour force survey (LFS. Absenteeism and the proportion of hours lost due to own illness or disability were modelled as a function of trend, seasonality and proxy variables for influenza activity from 1998 to 2009. Results Hours lost due to the H1N1/09 pandemic strain were elevated compared to seasonal influenza, accounting for a loss of 0.2% of potential hours worked annually. In comparison, an estimated 0.08% of hours worked annually were lost due to seasonal influenza illnesses. Absenteeism rates due to influenza were estimated at 12% per year for seasonal influenza over the 1997/98 to 2008/09 seasons, and 13% for the two H1N1/09 pandemic waves. Employees who took time off due to a seasonal influenza infection took an average of 14 hours off. For the pandemic strain, the average absence was 25 hours. Conclusions This study confirms that absenteeism due to seasonal influenza has typically ranged from 5% to 20%, with higher rates associated with multiple circulating strains. Absenteeism rates for the 2009 pandemic were similar to those occurring for seasonal influenza. Employees took more time off due to the pandemic strain than was typical for seasonal influenza.

Zheng Hui

2011-04-01

91

Natality Decline and Miscarriages Associated With the 1918 Influenza Pandemic: The Scandinavian and United States Experiences  

DEFF Research Database (Denmark)

Background.?Although pregnancy is a recognized risk factor for severe influenza infection, the effect of influenza on miscarriages and births remains unclear. We examined the relationship between influenza and birth rates during the 1918 pandemic in the United States, Denmark, Sweden, and Norway. Methods.?We compiled monthly birth rates from 1911 through 1930 in 3 Scandinavian countries and the United States, identified periods of unusually low or high birth rates, and quantified births as “missing” or “in excess” of the normal expectation. Using monthly influenza data, we correlated the timing of peak pandemic exposure and depressions in birth rates, and identified pregnancy stages at risk of influenza-related miscarriage. Results.?Birth rates declined in all study populations in spring 1919 by a mean of 2.2 births per 1000 persons, representing a 5%–15% drop below baseline levels (P < .05). The 1919 natality depression reached its trough 6.1–6.8 months after the autumn pandemic peak, suggesting that missing births were attributable to excess first trimester miscarriages in ?1 in 10 women who were pregnant during the peak of the pandemic. Pandemic-related mortality was insufficient to explain observed patterns. Conclusions.?The observed birth depressions were consistent with pandemic influenza causing first trimester miscarriages in ?1 in 10 pregnant women. Causality is suggested by temporal synchrony across geographical areas.

Bloom-Feshbach, Kimberly; Simonsen, Lone

2011-01-01

92

Cross Sectional Survey of Influenza Antibodies before and during the 2009 Pandemic in Shenzhen, China  

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Much information is available for the 2009 H1N1 influenza immunity response, but little is known about the antibody change in seasonal influenza before and during the novel influenza A pandemic. In this study, we conducted a cross-sectional serological survey of 4 types of major seasonal influenza in March and September 2009 on a full range of age groups, to investigate seasonal influenza immunity response before and during the outbreak of the sH1N1 influenza in Shenzhen – the largest migra...

Wu, Chun-li; Lu, Juan; Wang, Maggie Haitian; Lv, Xing; Chen, Ying; Kung, Hsiang-fu; Zee, Benny; Cheng, Xiao-wen; He, Ming-liang

2013-01-01

93

The investigation of Risk factors of influenza pandemic H1N1  

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Full Text Available Introduction: Influenza pandemic H1N1 is an acute respiratory infectious disease that is combination of two types of influenza virus type A (H1N1. This study aimed to identify risk factors affecting influenza pandemic H1N1. Methods: In this case-control study, the cases were 18 positive cases of pandemic influenza H1N1 and the controls were the patients who were admitted during the same time as the cases to sections of Orthopedics, Urology, Surgery and Women of the same hospital for reasons other than influenza. The data were collected through a form by two experienced nurses and then were fed into SPSS, and were analyzed using independent T-test and chi-square. Results: A significant relationship was observed between pandemic H1N1 influenza infection and a history of domestic travel, contact with confirmed patients, respiratory diseases, and diabetes (P0.05. Conclusion: People with underlying diseases, especially respiratory diseases, diabetes, heart disease and a secondary infection and cardiovascular disease most likely are susceptible to influenza pandemic H1N1.

koorosh Holakooyi Naeini

2010-01-01

94

Influenza vaccination coverage against seasonal and pandemic influenza and their determinants in France: a cross-sectional survey  

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Full Text Available Abstract Background Following the emergence of the influenza A(H1N12009 virus, the French ministry of health decided to offer free vaccination against pandemic influenza to the entire French population. Groups of people were defined and prioritised for vaccination. Methods We took a random sample of the population of mainland France and conducted a retrospective cross-sectional telephone survey to estimate vaccination coverage against seasonal and pandemic influenza and to identify determinants of these vaccinations. Results 10,091 people were included in the survey. Overall seasonal influenza vaccination coverage (IVC remained stable in the population from the 2008-2009 season to the 2009-2010 season reaching 20.6% and 20.8% respectively. Overall pandemic IVC in the French population is estimated to be 11.1% (CI95%: 9.8 - 12.4. The highest pandemic IVC was observed in the 0-4 years age group. For individuals with health conditions associated with higher risk of influenza, pandemic IVC was estimated to be 12.2% (CI95%: 9.8 - 15.1. The main determinants associated with pandemic influenza vaccine uptake were: living in a household with a child adj: 2.0 (CI95%: 1.3 - 3.1 or with two children adj: 2.7 (CI95%: 1.4 - 5.1, living in a household where the head of the family is university graduate (>2 years, ORadj: 2.5 (CI95%: 1.5 - 4.1, or has a higher professional and managerial occupation, ORadj: 3.0 (CI95%: 1.5 - 5.5 and being vaccinated against seasonal influenza, ORadj: 7.1 (CI95%: 5.1 - 10.0. Being an individual with higher risk for influenza was not a determinant for pandemic influenza vaccine uptake. These determinants are not the same as those for seasonal influenza vaccination. Conclusions Overall A(H1N12009 influenza vaccine uptake remained low, particularly among individuals with higher risk for influenza and was lower than that observed for seasonal influenza. The reasons behind people's reluctance to be vaccinated need to be investigated further.

de Valk Henriette

2011-01-01

95

Report of the international forum on pandemic influenza 2010 Qingdao, China, 24-25 July 2010.  

Science.gov (United States)

The 2009 H1N1 influenza pandemic is the first pandemic to hit the world in the 21st century. According to World Health Organization (WHO) reports, as of 18 July 2010, more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, and over 18,336 people have died as a result of the disease [1]. In an effort to facilitate the exchange of strategic and operational experience in the fight against the pandemic, the Chinese Center for Disease Control and Prevention (China CDC), supported by the China Ministry of Health, in collaboration with WHO, the World Bank, the U.S. CDC, and co-organised with the Elsevier Publishing Group, hosted the International Forum on Pandemic Influenza 2010 in July. The two-day meeting, attended by over 600 international delegates, saw human health and animal health professionals discuss the current situation of the pandemic, the global response and vaccination strategies, pandemic surveillance and preparedness, and the animal-human interface in influenza and other emerging infectious diseases. A summary of the discussions is presented here. PMID:20887833

Varella, Andre

2010-11-10

96

Pandemic influenza preparedness: an ethical framework to guide decision-making  

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Full Text Available Abstract Background Planning for the next pandemic influenza outbreak is underway in hospitals across the world. The global SARS experience has taught us that ethical frameworks to guide decision-making may help to reduce collateral damage and increase trust and solidarity within and between health care organisations. Good pandemic planning requires reflection on values because science alone cannot tell us how to prepare for a public health crisis. Discussion In this paper, we present an ethical framework for pandemic influenza planning. The ethical framework was developed with expertise from clinical, organisational and public health ethics and validated through a stakeholder engagement process. The ethical framework includes both substantive and procedural elements for ethical pandemic influenza planning. The incorporation of ethics into pandemic planning can be helped by senior hospital administrators sponsoring its use, by having stakeholders vet the framework, and by designing or identifying decision review processes. We discuss the merits and limits of an applied ethical framework for hospital decision-making, as well as the robustness of the framework. Summary The need for reflection on the ethical issues raised by the spectre of a pandemic influenza outbreak is great. Our efforts to address the normative aspects of pandemic planning in hospitals have generated interest from other hospitals and from the governmental sector. The framework will require re-evaluation and refinement and we hope that this paper will generate feedback on how to make it even more robust.

Gibson Jennifer L

2006-12-01

97

Molecular epidemiology of influenza A virus infection in Cyprus in four consecutive seasons (2009 pandemic-2013).  

Science.gov (United States)

The aim of this study was to investigate the epidemiology of influenza A virus infection in Cyprus from the 2009 pandemic until 2013. Pandemic influenza A(H1N1)2009 virus infections outnumbered infections with other respiratory viruses until the end of 2009. The pandemic virus was also the prevalent influenza strain during influenza season 2010-2011; however, it was completely replaced by H3N2 subtype in the next season. During the most recent influenza season, 2012-2013, the pandemic strain was once again the only influenza A virus circulating in Cyprus. Full-length neuraminidase gene sequencing revealed mutations that had previously been identified as permissive. No significant difference in the expression of the IFN-inducible genes OAS and IFIT1 were observed. The phylogenetic analysis of the neuraminidase gene sequences revealed a picture of continuous importation of influenza strains in the island of Cyprus with local circulation playing only a minor role in determining the prevalent strain of the next influenza season. PMID:24152574

Panayiotou, C; Richter, J; Bashiardes, S; Koptides, D; Tryfonos, C; Christodoulou, C

2014-05-01

98

The pandemic (H1N1 2009 influenza virus is resistant to mannose-binding lectin  

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Full Text Available Abstract Background Mannose-binding lectin (MBL is an important component of innate immunity because it promotes bacterial clearance and neutralization of human influenza A viruses. Since a majority of humans have no neutralizing antibody against the pandemic (H1N1 2009 influenza (pandemic 2009 virus, innate immunity may be crucial and MBL susceptibility may therefore influence viral pathogenesis. Results We examined MBL susceptibility of influenza A viruses and observed that the pandemic 2009 virus was resistant to MBL, whereas all seasonal influenza A viruses tested were susceptible. The mortality of mice infected with a seasonal H1N1 influenza virus was evidently enhanced on transient blockage of MBL activity by simultaneous inoculation of mannan, whereas mannan inoculation had no effect on mice infected with a pandemic 2009 virus. This indicates that MBL protects mice against infection with the seasonal virus but not against that with the pandemic 2009 virus. Conclusions These results indicate that the pandemic 2009 virus is not susceptible to MBL, an important component of innate immunity.

Ushirogawa Hiroshi

2011-02-01

99

Modelling seasonality and viral mutation to predict the course of an influenza pandemic  

Science.gov (United States)

SUMMARY As the 2009 H1N1 influenza pandemic (H1N1) has shown, public health decision-makers may have to predict the subsequent course and severity of a pandemic. We developed an agent-based simulation model and used data from the state of Georgia to explore the influence of viral mutation and seasonal effects on the course of an influenza pandemic. We showed that when a pandemic begins in April certain conditions can lead to a second wave in autumn (e.g. the degree of seasonality exceeding 0·30, or the daily rate of immunity loss exceeding 1% per day). Moreover, certain combinations of seasonality and mutation variables reproduced three-wave epidemic curves. Our results may offer insights to public health officials on how to predict the subsequent course of an epidemic or pandemic based on early and emerging viral and epidemic characteristics and what data may be important to gather. PMID:20158932

SHI, P.; KESKINOCAK, P.; SWANN, J. L.; LEE, B. Y.

2013-01-01

100

Modelling seasonality and viral mutation to predict the course of an influenza pandemic.  

Science.gov (United States)

As the 2009 H1N1 influenza pandemic (H1N1) has shown, public health decision-makers may have to predict the subsequent course and severity of a pandemic. We developed an agent-based simulation model and used data from the state of Georgia to explore the influence of viral mutation and seasonal effects on the course of an influenza pandemic. We showed that when a pandemic begins in April certain conditions can lead to a second wave in autumn (e.g. the degree of seasonality exceeding 0.30, or the daily rate of immunity loss exceeding 1% per day). Moreover, certain combinations of seasonality and mutation variables reproduced three-wave epidemic curves. Our results may offer insights to public health officials on how to predict the subsequent course of an epidemic or pandemic based on early and emerging viral and epidemic characteristics and what data may be important to gather. PMID:20158932

Shi, P; Keskinocak, P; Swann, J L; Lee, B Y

2010-10-01

 
 
 
 
101

Capacity Building in Response to Pandemic Influenza Threats: Lao PDR Case Study  

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The Lao People's Democratic Republic (PDR) committed to pandemic detection and response preparations when faced with the threat of avian influenza. Since 2006, the National Center for Laboratory and Epidemiology of Lao PDR has developed credible laboratory, surveillance, and epidemiological (human) capacity and as a result was designated a World Health Organization National Influenza Center in 2010. The Lao PDR experience in building influenza capacities provides a case study of the considera...

Phommasack, Bounlay; Moen, Ann; Vongphrachanh, Phengta; Tsuyuoka, Reiko; Cox, Nancy; Khamphaphongphanh, Bouaphanh; Phonekeo, Darouny; Kasai, Takeshi; Ketmayoon, Pakapak; Lewis, Hannah; Kounnavong, Bounheuang; Khanthamaly, Viengphone; Corwin, Andrew

2012-01-01

102

Reduced influenza antiviral treatment among children and adults hospitalized with laboratory-confirmed influenza infection in the year after the 2009 pandemic.  

Science.gov (United States)

Influenza antiviral treatment is recommended for all persons hospitalized with influenza virus infection. During the 2010-2011 influenza season, antiviral treatment of children and adults hospitalized with laboratory-confirmed influenza declined significantly compared with treatment during the 2009 pandemic (children, 56% vs 77%; adults, 77% vs 82%; both P < .01). PMID:22543024

Garg, Shikha; Chaves, Sandra S; Pérez, Alejandro; D'Mello, Tiffany; Gershman, Ken; Meek, James; Yousey-Hindes, Kimberly; Arnold, Kathryn E; Farley, Monica M; Tengelsen, Leslie; Ryan, Patricia; Sharangpani, Ruta; Lynfield, Ruth; Morin, Craig; Baumbach, Joan; Hancock, Emily B; Zansky, Shelley; Bennett, Nancy M; Fowler, Brian; Bradley, Kristy; Thomas, Ann; Cooper, Tara; Schaffner, William; Boulton, Rachelle; Finelli, Lyn; Fry, Alicia M

2012-08-01

103

Early-warning signals for an outbreak of the influenza pandemic  

International Nuclear Information System (INIS)

Over the course of human history, influenza pandemics have been seen as major disasters, so studies on the influenza virus have become an important issue for many experts and scholars. Comprehensive research has been performed over the years on the biological properties, chemical characteristics, external environmental factors and other aspects of the virus, and some results have been achieved. Based on the chaos game representation walk model, this paper uses the time series analysis method to study the DNA sequences of the influenza virus from 1913 to 2010, and works out the early-warning signals indicator value for the outbreak of an influenza pandemic. The variances in the CGR walk sequences for the pandemic years (or + ?1 to 2 years) are significantly higher than those for the adjacent years, while those in the non-pandemic years are usually smaller. In this way we can provide an influenza early-warning mechanism so that people can take precautions and be well prepared prior to a pandemic. (interdisciplinary physics and related areas of science and technology)

104

Comparative age distribution of influenza morbidity and mortality during seasonal influenza epidemics and the 2009 H1N1 pandemic  

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Abstract Background Several studies have shown a relatively high mortality rate among young people infected by the 2009 pandemic influenza A (H1N1) virus. Here we compared the age distributions of morbidity and mortality during two seasonal influenza epidemics (H1N1 and H3N2) in France and the United States with those of the 2009 H1N1 pandemic waves in the same countries. Methods Age-standardized ratios were used to compare the age distribution of morbidity and ...

Lemaitre Magali; Carrat Fabrice

2010-01-01

105

[Trends in the spread of pandemic influenza A(H1N1) swl in the Far East in 2009].  

Science.gov (United States)

The paper describes the trend in the spread of pandemic influenza A(H1N1) swl virus in the Far East, which started in this region 2-3 months later than that in the European part of Russia. By mid-October seasonal epidemic influenza was practically displaced by pandemic one. PMID:20608075

Shchelkanov, M Iu; L'vov, D N; Fediakina, I T; Baranov, N I; Gorelikov, V N; Reznik, V Ia; Zdanovskaia, N I; Pukhovskaia, N M; Avdoshina, L N; Shapiro, N I; Snetkova, I P; Kozhan, V N; Iarovenko, G M; Kalaeva, E E; Gromova, M A; Elovski?, O V; Eremeeva, Iu V; Dovgal', M A; Kuchenkov, A A; Anan'ev, V Iu; Burtnik, V I; Ivanov, L I; Garbuz, Iu A; Podolianko, I A; Grigor'ev, S N; Proshina, E S; Samokhvalov, E I; Al'khovski?, S V; Burtseva, E I; Prilipov, A G; Abbasova, E I; Mironenko, E S; Kolobukhina, L V; Deriabin, P G; Ott, V A; Maslov, D V; Ianovich, V A; L'vov, D K

2010-01-01

106

Increased Extent of and Risk Factors for Pandemic (H1N1) 2009 and Seasonal Influenza among Children, Israel  

Science.gov (United States)

During the pandemic (H1N1) 2009 outbreak in Israel, incidence rates among children were 2× higher than that of the previous 4 influenza seasons; hospitalization rates were 5× higher. Children hospitalized for pandemic (H1N1) 2009 were older and had more underlying chronic diseases than those hospitalized for seasonal influenza. PMID:21888809

Bromberg, Michal; Averbuch, Diana; Tenenbaum, Ariel; Goldmann, Daniele; Kunin, Marina; Shmueli, Einat; Yatsiv, Ido; Weintraub, Michael; Mandelboim, Michal; Strauss-Liviatan, Nurith; Anis, Emilia; Mendelson, Ella; Shohat, Tamy; Wolf, Dana G.; Shapiro, Mervyn; Grotto, Itamar

2011-01-01

107

Antiviral Prophylaxis and Isolation for the Control of Pandemic Influenza  

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Full Text Available Before effective vaccines become available, antiviral drugs are considered as the major control strategies for a pandemic influenza. However, perhaps such control strategies can be severely hindered by the low-efficacy of antiviral drugs. For this reason, using antiviral drugs and an isolation strategy is included in our study. A compartmental model that allows for imported exposed individuals and asymptomatic cases is used to evaluate the effectiveness of control strategies via antiviral prophylaxis and isolation. Simulations show that isolation strategy plays a prominent role in containing transmission when antiviral drugs are not effective enough. Moreover, relatively few infected individuals need to be isolated per day. Because the accurate calculations of the needed numbers of antiviral drugs and the isolated infected are not easily available, we give two simple expressions approximating these numbers. We also derive an estimation for the total cost of these intervention strategies. These estimations obtained by a simple method provide a useful reference for the management department about the epidemic preparedness plans.

Qingxia Zhang

2014-07-01

108

Influenza surveillance in the Pacific Island countries and territories during the 2009 pandemic: an observational study  

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Full Text Available Abstract Background Historically, Pacific island countries and territories (PICTs have been more severely affected by influenza pandemics than any other part of the world. We herein describe the emergence and epidemiologic characteristics of pandemic influenza H1N1 in PICTs from 2009 to 2010. Methods The World Health Organization gathered reports of influenza-like-illness and laboratory-confirmed pandemic H1N1 cases from all 23 Pacific island countries and territories, from April 2009 through August 2010. Data were gathered through weekly email reports from Pacific island countries and territories and through email or telephone follow-up. Results Pacific island countries and territories started detecting pandemic H1N1 cases in June 2009, firstly in French Polynesia, with the last new detection occurring in August 2009 in Tuvalu. Nineteen Pacific island countries and territories reported 1,972 confirmed cases, peaking in August 2009. No confirmed pandemic H1N1 cases were identified in Niue, Pitcairn and Tokelau; the latter instituted strict maritime quarantine. Influenza-like-illness surveillance showed trends similar to surveillance of confirmed cases. Seven Pacific island countries and territories reported 21 deaths of confirmed pandemic H1N1. Case-patients died of acute respiratory distress syndrome or multi-organ failure, or both. The most reported pre-existing conditions were obesity, lung disease, heart disease, and pregnancy. Pacific island countries and territories instituted a variety of mitigation measures, including arrival health screening. Multiple partners facilitated influenza preparedness planning and outbreak response. Conclusions Pandemic influenza spread rapidly throughout the Pacific despite enormous distances and relative isolation. Tokelau and Pitcairn may be the only jurisdictions to have remained pandemic-free. Despite being well-prepared, Pacific island countries and territories experienced significant morbidity and mortality, consistent with other indigenous and low-resource settings. For the first time, regional influenza-like-illness surveillance was conducted in the Pacific, allowing health authorities to monitor the pandemic’s spread and severity in real-time. Future regional outbreak responses will likely benefit from the lessons learned during this outbreak.

Kool Jacobus Leen

2013-01-01

109

The development of vaccine viruses against pandemic A(H1N1) influenza.  

Science.gov (United States)

Wild type human influenza viruses do not usually grow well in embryonated hens' eggs, the substrate of choice for the production of inactivated influenza vaccine, and vaccine viruses need to be developed specifically for this purpose. In the event of a pandemic of influenza, vaccine viruses need to be created with utmost speed. At the onset of the current A(H1N1) pandemic in April 2009, a network of laboratories began a race against time to develop suitable candidate vaccine viruses. Two approaches were followed, the classical reassortment approach and the more recent reverse genetics approach. This report describes the development and the characteristics of current pandemic H1N1 candidate vaccine viruses. PMID:21199698

Robertson, James S; Nicolson, Carolyn; Harvey, Ruth; Johnson, Rachel; Major, Diane; Guilfoyle, Kate; Roseby, Sarah; Newman, Robert; Collin, Rebecca; Wallis, Chantal; Engelhardt, Othmar G; Wood, John M; Le, Jianhua; Manojkumar, Ramanunninair; Pokorny, Barbara A; Silverman, Jeanmarie; Devis, Rene; Bucher, Doris; Verity, Erin; Agius, Catherine; Camuglia, Sarina; Ong, Chi; Rockman, Steven; Curtis, Anne; Schoofs, Peter; Zoueva, Olga; Xie, Hang; Li, Xing; Lin, Zhengshi; Ye, Zhiping; Chen, Li-Mei; O'Neill, Eduardo; Balish, Amanda; Lipatov, Aleksandr S; Guo, Zhu; Isakova, Irina; Davis, Charles T; Rivailler, Pierre; Gustin, Kortney M; Belser, Jessica A; Maines, Taronna R; Tumpey, Terrence M; Xu, Xiyan; Katz, Jacqueline M; Klimov, Alexander; Cox, Nancy J; Donis, Ruben O

2011-02-17

110

The potential impact of the next influenza pandemic on a national primary care medical workforce  

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Abstract Background Another influenza pandemic is all but inevitable. We estimated its potential impact on the primary care medical workforce in New Zealand, so that planning could mitigate the disruption from the pandemic and similar challenges. Methods The model in the "FluAid" software (Centers for Disease Control and Prevention, CDC, Atlanta) was applied to the New Zealand primary care medical workforce (i.e., general practitioners). Results At...

Crampton Peter; Baker Michael; Wilson Nick; Mansoor Osman

2005-01-01

111

Capacity Building in Response to Pandemic Influenza Threats: Lao PDR Case Study  

Science.gov (United States)

The Lao People's Democratic Republic (PDR) committed to pandemic detection and response preparations when faced with the threat of avian influenza. Since 2006, the National Center for Laboratory and Epidemiology of Lao PDR has developed credible laboratory, surveillance, and epidemiological (human) capacity and as a result was designated a World Health Organization National Influenza Center in 2010. The Lao PDR experience in building influenza capacities provides a case study of the considerable crossover effect of such investments to augment the capacity to combat emerging and re-emerging diseases other than influenza. PMID:23222137

Phommasack, Bounlay; Moen, Ann; Vongphrachanh, Phengta; Tsuyuoka, Reiko; Cox, Nancy; Khamphaphongphanh, Bouaphanh; Phonekeo, Darouny; Kasai, Takeshi; Ketmayoon, Pakapak; Lewis, Hannah; Kounnavong, Bounheuang; Khanthamaly, Viengphone; Corwin, Andrew

2012-01-01

112

Influenza pandemic and professional duty: family or patients first? A survey of hospital employees  

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Full Text Available Abstract Background Conflicts between professional duties and fear of influenza transmission to family members may arise among health care professionals (HCP. Methods We surveyed employees at our university hospital regarding ethical issues arising during the management of an influenza pandemic. Results Of 644 respondents, 182 (28% agreed that it would be professionally acceptable for HCP to abandon their workplace during a pandemic in order to protect themselves and their families, 337 (52% disagreed with this statement and 125 (19% had no opinion, with a higher rate of disagreement among physicians (65% and nurses (54% compared with administrators (32%. Of all respondents, 375 (58% did not believe that the decision to report to work during a pandemic should be left to the individual HCP and 496 (77% disagreed with the statement that HCP should be permanently dismissed for not reporting to work during a pandemic. Only 136 (21% respondents agreed that HCW without children should primarily care for the influenza patients. Conclusion Our results suggest that a modest majority of HCP, but only a minority of hospital administrators, recognises the obligation to treat patients despite the potential risks. Professional ethical guidelines allowing for balancing the needs of society with personal risks are needed to help HCP fulfil their duties in the case of a pandemic influenza.

Hanses Frank

2006-12-01

113

Emergency department visits for antiviral adverse events during the 2009 H1N1 influenza pandemic.  

Science.gov (United States)

The 2009 pandemic influenza A (H1N1) outbreak was associated with an increased use of antiviral agents and highlighted the role of population-based monitoring for related adverse drug events (ADEs). An ongoing, nationally representative emergency department-based surveillance system was used to identify and characterize ADEs during the pandemic. Active surveillance for ADEs successfully provided timely, population-based data during the pandemic. Increases in antiviral ADEs paralleled increases in prescribing. Type and severity of ADEs were similar across all seasons. PMID:21553658

Lovegrove, Maribeth C; Shehab, Nadine; Hales, Craig M; Poneleit, Kathy; Crane, Elizabeth; Budnitz, Daniel S

2011-01-01

114

School opening dates predict pandemic influenza A (H1N1) epidemics in the USA  

Science.gov (United States)

The opening of schools in late summer of 2009 may have triggered the fall wave of pandemic influenza A(H1N1) in the United States. We found that elevated percent of outpatient visits for influenza-like illness (ILI%) occurred an average of 14 days after schools opened in a state in the fall of 2009. The timing of these events was highly correlated (Spearman’s correlation coefficient=0.62, p < 1.0 × 10?5). This result provides evidence that transmission in schools catalyzes community-wide transmission. School opening dates can be useful for future pandemic planning, and influenza mitigation strategies should be targeted at school populations before the influenza season. PMID:20704486

Chao, Dennis L.; Halloran, M. Elizabeth; Longini, Ira M.

2010-01-01

115

Searching of Main Cause Leading to Severe Influenza A Virus Mutations and Consequently to Influenza Pandemics/Epidemics  

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Full Text Available The unpredictable mutations in the proteins from influenza A virus lead to the great difficulty in prevention of possible outbreak of bird flu and pandemic/epidemic of influenza. This unpredictability is due to the fact that we know little about the causes that lead to the mutations. In three of our recent studies on the hemagglutinins from influenza A virus, we unintentionally noticed the periodicity of mutations in hemagglutinins similar to the periodicity of sunspot. We calculated the amino-acid pair predictability and amino-acid distribution rank, which are developed by us over last several years and can numerically present the evolution of proteins in question, of 1217 full-length hemagglutinins from influenza A viruses. We then used the fast Fourier transform to determine the periodicity of mutations in the hemagglutinins. We compare the periodicities of mutations in influenza A virus hemagglutinins with those of solar and galactic cosmic rays and find a main periodicity of the mutations identical to that of sunspot and neutron rate (11 years/circle. Then we plot the sunspot number with respect to the historical pandemics/epidemics/non-pandemic new strains over last three centuries and compare the recorded sunspots with the historical pandemics before 1700. Both show a good agreement between sunspot activity and influenza related events. As the histories of Sun and galaxy are incomparably much longer than the history of influenza virus, the only logical deduction is that the hemagglutinin periodicities, which are identical to the periodicities of solar and galactic cosmic rays, are attribute to the solar and galactic activity. As the hemagglutinin is a sample of influenza A virus, we can logically deduce the role of migratory wild birds on the outbreak of bird flu and influenza, that is, cosmic rays are heading towards the polar regions, where more mutations occur in influenza A virus either within the wild birds or in their living environments and as the winter approaches, these waterfowl fly forwards warm south bringing back the new mutated influenza A virus leading to outbreak of bird flu or influenza.

Guang Wu

2005-01-01

116

Non-pharmaceutical public health interventions for pandemic influenza: an evaluation of the evidence base  

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Full Text Available Abstract Background In an influenza pandemic, the benefit of vaccines and antiviral medications will be constrained by limitations on supplies and effectiveness. Non-pharmaceutical public health interventions will therefore be vital in curtailing disease spread. However, the most comprehensive assessments of the literature to date recognize the generally poor quality of evidence on which to base non-pharmaceutical pandemic planning decisions. In light of the need to prepare for a possible pandemic despite concerns about the poor quality of the literature, combining available evidence with expert opinion about the relative merits of non-pharmaceutical interventions for pandemic influenza may lead to a more informed and widely accepted set of recommendations. We evaluated the evidence base for non-pharmaceutical public health interventions. Then, based on the collective evidence, we identified a set of recommendations for and against interventions that are specific to both the setting in which an intervention may be used and the pandemic phase, and which can be used by policymakers to prepare for a pandemic until scientific evidence can definitively respond to planners' needs. Methods Building on reviews of past pandemics and recent historical inquiries, we evaluated the relative merits of non-pharmaceutical interventions by combining available evidence from the literature with qualitative and quantitative expert opinion. Specifically, we reviewed the recent scientific literature regarding the prevention of human-to-human transmission of pandemic influenza, convened a meeting of experts from multiple disciplines, and elicited expert recommendation about the use of non-pharmaceutical public health interventions in a variety of settings (healthcare facilities; community-based institutions; private households and pandemic phases (no pandemic; no US pandemic; early localized US pandemic; advanced US pandemic. Results The literature contained a dearth of evidence on the efficacy or effectiveness of most non-pharmaceutical interventions for influenza. In an effort to inform decision-making in the absence of strong scientific evidence, the experts ultimately endorsed hand hygiene and respiratory etiquette, surveillance and case reporting, and rapid viral diagnosis in all settings and during all pandemic phases. They also encouraged patient and provider use of masks and other personal protective equipment as well as voluntary self-isolation of patients during all pandemic phases. Other non-pharmaceutical interventions including mask-use and other personal protective equipment for the general public, school and workplace closures early in an epidemic, and mandatory travel restrictions were rejected as likely to be ineffective, infeasible, or unacceptable to the public. Conclusion The demand for scientific evidence on non-pharmaceutical public health interventions for influenza is pervasive, and present policy recommendations must rely heavily on expert judgment. In the absence of a definitive science base, our assessment of the evidence identified areas for further investigation as well as non-pharmaceutical public health interventions that experts believe are likely to be beneficial, feasible and widely acceptable in an influenza pandemic.

Wasserman Jeffrey

2007-08-01

117

Acceptance of a pandemic influenza vaccine: a systematic review of surveys of the general public  

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Full Text Available Trang Nguyen1,2, Kirsten Holdt Henningsen1, Jamie C Brehaut1,2, Erica Hoe1, Kumanan Wilson1,3 1Clinical Epidemiology Program, Ottawa Hospital Research Institute; 2Epidemiology and Community Medicine, University of Ottawa; 3Department of Medicine, University of Ottawa, Ottawa, Canada Introduction: The effectiveness of pandemic vaccine campaigns such as the H1N1 vaccine rollout is dependent on both the vaccines’ effectiveness and the general public’s willingness to be vaccinated. It is therefore critical to understand the factors that influence the decision of members of the public whether to get vaccinated with new, emergently released vaccines. Methods: A systematic review of English language quantitative surveys was conducted to identify consistent predictors of the decision to accept or decline any (prepandemic vaccine, including the H1N1 influenza A vaccine. A total of ten studies were included in this review and all pertained to the 2009 H1N1 influenza A pandemic. Respondents’ willingness to receive a pandemic vaccine ranged from 8%–67% across the ten studies. The factors reported to be consistent predictors of the intention to vaccinate were: risk of infection, proximity or severity of the public health event, severity of personal consequences resulting from the illness, harm or adverse events from the vaccine, acceptance of previous vaccination, and ethnicity. Age and sex were the demographic variables examined most frequently across the ten studies and there was no consistent association between these variables and the intention to accept or reject a pandemic vaccine. Conclusion: Some predictors of the intention to accept or decline a (prepandemic vaccine or the H1N1 influenza A vaccine are consistently identified by surveys. Understanding the important factors influencing the acceptance of a pandemic vaccine by individual members of the public may help inform strategies to improve vaccine uptake during future pandemics. Keywords: pandemic, H1N1 influenza A, emergent vaccine, personal risk, demographic

Nguyen T

2011-10-01

118

Pandemic Influenza A (H1N1 virus-associated acute myopericarditis  

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Full Text Available Although pandemic influenza A (H1N1 virus may cause an upper respiratory tract infection similar to that caused by seasonal influenza, it can lead to serious complications such as pneumonia, encephalitis, and myocarditis. We describe a 2-year-old girl admitted with fever, cough, and vomiting followed by acute respiratory distress and diagnosed as H1N1-related myopericarditis. (Turk Arch Ped 2011; 46: 337-9

Yakup

2011-12-01

119

A two-year surveillance of 2009 pandemic influenza A (H1N1) in Guangzhou, China: from pandemic to seasonal influenza?  

Digital Repository Infrastructure Vision for European Research (DRIVER)

In this two-years surveillance of 2009 pandemic influenza A (H1N1) (pH1N1) in Guangzhou, China, we reported here that the scale and duration of pH1N1 outbreaks, severe disease and fatality rates of pH1N1 patients were significantly lower or shorter in the second epidemic year (May 2010-April 2011) than those in the first epidemic year (May 2009-April 2010) (P0.05). Similar to seasonal influenza, pre-existing chronic pulmonary diseases was ...

Li, Tiegang; Fu, Chuanxi; Di, Biao; Wu, Jibin; Yang, Zhicong; Wang, Yulin; Li, Meixia; Lu, Jianyun; Chen, Yiyun; Lu, Enjie; Geng, Jinmei; Hu, Wensui; Dong, Zhiqiang; Li, Meng-feng; Zheng, Bo-jian

2011-01-01

120

Geographical spread of influenza incidence in Spain during the 2009 A(H1N1) pandemic wave and the two succeeding influenza seasons.  

Science.gov (United States)

SUMMARY The aim of this study was to monitor the spatio-temporal spread of influenza incidence in Spain during the 2009 pandemic and the following two influenza seasons 2010-2011 and 2011-2012 using a Bayesian Poisson mixed regression model; and implement this model of geographical analysis in the Spanish Influenza Surveillance System to obtain maps of influenza incidence for every week. In the pandemic wave the maps showed influenza activity spreading from west to east. The 2010-2011 influenza epidemic wave plotted a north-west/south-east pattern of spread. During the 2011-2012 season the spread of influenza was geographically heterogeneous. The most important source of variability in the model is the temporal term. The model of spatio-temporal spread of influenza incidence is a supplementary tool of influenza surveillance in Spain. PMID:24476599

Gomez-Barroso, D; Martinez-Beneito, M A; Flores, V; Amorós, R; Delgado, C; Botella, P; Zurriaga, O; Larrauri, A

2014-12-01

 
 
 
 
121

Modeling uncertainties in workforce disruptions from influenza pandemics using dynamic input-output analysis.  

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Influenza pandemic is a serious disaster that can pose significant disruptions to the workforce and associated economic sectors. This article examines the impact of influenza pandemic on workforce availability within an interdependent set of economic sectors. We introduce a simulation model based on the dynamic input-output model to capture the propagation of pandemic consequences through the National Capital Region (NCR). The analysis conducted in this article is based on the 2009 H1N1 pandemic data. Two metrics were used to assess the impacts of the influenza pandemic on the economic sectors: (i) inoperability, which measures the percentage gap between the as-planned output and the actual output of a sector, and (ii) economic loss, which quantifies the associated monetary value of the degraded output. The inoperability and economic loss metrics generate two different rankings of the critical economic sectors. Results show that most of the critical sectors in terms of inoperability are sectors that are related to hospitals and health-care providers. On the other hand, most of the sectors that are critically ranked in terms of economic loss are sectors with significant total production outputs in the NCR such as federal government agencies. Therefore, policy recommendations relating to potential mitigation and recovery strategies should take into account the balance between the inoperability and economic loss metrics. PMID:24033717

El Haimar, Amine; Santos, Joost R

2014-03-01

122

Healthcare workers' attitudes to working during pandemic influenza: a qualitative study  

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Full Text Available Abstract Background Healthcare workers (HCWs will play a key role in any response to pandemic influenza, and the UK healthcare system's ability to cope during an influenza pandemic will depend, to a large extent, on the number of HCWs who are able and willing to work through the crisis. UK emergency planning will be improved if planners have a better understanding of the reasons UK HCWs may have for their absenteeism, and what might motivate them to work during an influenza pandemic. This paper reports the results of a qualitative study that explored UK HCWs' views (n = 64 about working during an influenza pandemic, in order to identify factors that might influence their willingness and ability to work and to identify potential sources of any perceived duty on HCWs to work. Methods A qualitative study, using focus groups (n = 9 and interviews (n = 5. Results HCWs across a range of roles and grades tended to feel motivated by a sense of obligation to work through an influenza pandemic. A number of significant barriers that may prevent them from doing so were also identified. Perceived barriers to the ability to work included being ill oneself, transport difficulties, and childcare responsibilities. Perceived barriers to the willingness to work included: prioritising the wellbeing of family members; a lack of trust in, and goodwill towards, the NHS; a lack of information about the risks and what is expected of them during the crisis; fear of litigation; and the feeling that employers do not take the needs of staff seriously. Barriers to ability and barriers to willingness, however, are difficult to separate out. Conclusion Although our participants tended to feel a general obligation to work during an influenza pandemic, there are barriers to working, which, if generalisable, may significantly reduce the NHS workforce during a pandemic. The barriers identified are both barriers to willingness and to ability. This suggests that pandemic planning needs to take into account the possibility that staff may be absent for reasons beyond those currently anticipated in UK planning documents. In particular, staff who are physically able to attend work may nonetheless be unwilling to do so. Although there are some barriers that cannot be mitigated by employers (such as illness, transport infrastructure etc., there are a number of remedial steps that can be taken to lesson the impact of others (providing accommodation, building reciprocity, provision of information and guidance etc. We suggest that barriers to working lie along an ability/willingness continuum, and that absenteeism may be reduced by taking steps to prevent barriers to willingness becoming perceived barriers to ability.

Petts Judith I

2009-02-01

123

Existing health inequalities in India: informing preparedness planning for an influenza pandemic.  

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On 11 June 2009, the World Health Organization (WHO) declared that the world was in phase 6 of an influenza pandemic. In India, the first case of 2009 H1N1 influenza was reported on 16 May 2009 and by August 2010 (when the pandemic was declared over), 38730 cases of 2009 H1N1 had been confirmed of which there were 2024 deaths. Here, we propose a conceptual model of the sources of health disparities in an influenza pandemic in India. Guided by a published model of the plausible sources of such disparities in the United States, we reviewed the literature for the determinants of the plausible sources of health disparities during a pandemic in India. We find that factors at multiple social levels could determine inequalities in the risk of exposure and susceptibility to influenza, as well as access to treatment once infected: (1) religion, caste and indigenous identity, as well as education and gender at the individual level; (2) wealth at the household level; and (3) the type of location, ratio of health care practitioners to population served, access to transportation and public spending on health care in the geographic area of residence. Such inequalities could lead to unequal levels of disease and death. Whereas causal factors can only be determined by testing the model when incidence and mortality data, collected in conjunction with socio-economic and geographic factors, become available, we put forth recommendations that policy makers can undertake to ensure that the pandemic preparedness plan includes a focus on social inequalities in India in order to prevent their exacerbation in a pandemic. PMID:22131367

Kumar, Supriya; Quinn, Sandra C

2012-09-01

124

Swine influenza (H1N1) pandemic: developing countries' perspective.  

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Since the first case of the current pandemic (H1N1) 2009 virus reported to WHO on 24 April 2009 on the American continent, the virus has spread in 160 countries and territories. By mid-2009, there were 135,000 cases and 816 deaths recorded. Pandemic preparedness is not advanced in most developing countries. Effective and essential measures include heightened surveillance, early detection and appropriate medical care. The use of local resources and capacity building with the assistance of developed nations will reduce the impact of this pandemic in the developing world. PMID:19681650

Khan, S I; Akbar, S M F; Hossain, S T; Mahtab, M A

2009-01-01

125

Evaluation of the Children Hospitalized with Pandemic H1N1 Influenza  

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Full Text Available Objective: In April 2009, a new influenza virus (H1N1 emerged in Mexico and USA that quickly spread worldwide and the World Health Organization declared this outbreak as the first influenza pandemic of the 21st century. The aim of this study was to evaluate the laboratory confirmed children hospitalized due to pandemic influenza in our hospital.Material and Methods: Fifty-six patients who were hospitalized between October 1, 2009 and January 31, 2010 due to pandemic influenza, were followed prospectively in the Department of Pediatric Infectious Diseases,Erciyes University Medical Faculty, and patients with laboratory confirmed tests were included in this study. Results: Seventy three percent of the patients hospitalized due to pandemic influenza (n=41/56 were confirmed and 37 patients were included in this study. Median age was 6.2 years (1 month-18 years and 51.4% of the patients were female. The most common symptoms were fever (83.8%, cough (81.1% and respiratory distress (45.9%. The most common finding was pharyngeal hyperemia (89.2%. It was determined that 48.6% of the patients (n=17/35 had increased aspartate aminotransferase levels, 42.9% of the patients (n=9/21 had increased creatine kinase levels, and 18% of the patients (n=6/33 had increased alanine aminotransferase levels. Six patients (16.2% had leukopenia, seven (18.9% had neutropenia (absolute neutrophil count <1500/mm3 and eleven (29.7% had lymphopenia. Underlying diseases were detected in 64.9% of the patients (n=24 and 45.8% of these patients (n=11 had neurological diseases. Five patients required intensive care and mechanical ventilation, four of them (10.8% died. Conclusion: H1N1 infection in children had features similar to those of seasonal influenza. Underlying medical conditions can increase the morbidity and mortality of the disease.

Meda Kondolot

2010-12-01

126

Local public health workers' perceptions toward responding to an influenza pandemic  

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Full Text Available Abstract Background Current national preparedness plans require local health departments to play an integral role in responding to an influenza pandemic, a major public health threat that the World Health Organization has described as "inevitable and possibly imminent". To understand local public health workers' perceptions toward pandemic influenza response, we surveyed 308 employees at three health departments in Maryland from March – July 2005, on factors that may influence their ability and willingness to report to duty in such an event. Results The data suggest that nearly half of the local health department workers are likely not to report to duty during a pandemic. The stated likelihood of reporting to duty was significantly greater for clinical (Multivariate OR: 2.5; CI 1.3–4.7 than technical and support staff, and perception of the importance of one's role in the agency's overall response was the single most influential factor associated with willingness to report (Multivariate OR: 9.5; CI 4.6–19.9. Conclusion The perceived risk among public health workers was shown to be associated with several factors peripheral to the actual hazard of this event. These risk perception modifiers and the knowledge gaps identified serve as barriers to pandemic influenza response and must be specifically addressed to enable effective local public health response to this significant threat.

Everly George S

2006-04-01

127

The potential impact of the next influenza pandemic on a national primary care medical workforce  

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Full Text Available Abstract Background Another influenza pandemic is all but inevitable. We estimated its potential impact on the primary care medical workforce in New Zealand, so that planning could mitigate the disruption from the pandemic and similar challenges. Methods The model in the "FluAid" software (Centers for Disease Control and Prevention, CDC, Atlanta was applied to the New Zealand primary care medical workforce (i.e., general practitioners. Results At its peak (week 4 the pandemic would lead to 1.2% to 2.7% loss of medical work time, using conservative baseline assumptions. Most workdays (88% would be lost due to illness, followed by hospitalisation (8%, and then premature death (4%. Inputs for a "more severe" scenario included greater health effects and time spent caring for sick relatives. For this scenario, 9% of medical workdays would be lost in the peak week, and 3% over a more compressed six-week period of the first pandemic wave. As with the base case, most (64% of lost workdays would be due to illness, followed by caring for others (31%, hospitalisation (4%, and then premature death (1%. Conclusion Preparedness planning for future influenza pandemics must consider the impact on this medical workforce and incorporate strategies to minimise this impact, including infection control measures, well-designed protocols, and improved health sector surge capacity.

Crampton Peter

2005-08-01

128

Seroprevalence study in Vojvodina (Serbia following 2009 pandemic influenza A(H1N1v  

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Full Text Available Introduction. The seroprevalence study was performed in Vojvodina during May and June 2010 in order to asses the effects of the 2009 pandemic influenza A(H1N1v epidemic on herd immunity. It was a part of the Serbian Ministry of Health funded nationwide study. Objective. Prevalence of antibodies against 2009 pandemic influenza A(H1N1v was determined in a 1% sample of the population monitored for influenza-like illness and acute respiratory infections in Vojvodina through sentinel surveillance system. Methods. The study sample involved a total of 1004 inhabitants of Vojvodina. The control group consisted of randomly selected and age-adjusted 1054 sera collected in the pre-pandemic period. Sera were tested by the reaction of hemagglutination inhibition using influenza A/California/7/2009 (H1N1 antigen in dilution from 1:8 to 1:256. Antibody titers ?1:32 and ?1:8 were considered protective and diagnostic, respectively. Results. The differences between control and study sera in all age groups were significant for both diagnostic ?1/8 and protective titres ?1/32 of hemagglutination inhibition antibodies (chi square test, p<0.001. The highest percentage of seropositive subjects was registered in the age group 15-19 years followed by children aged 5-14 years. Both diagnostic and protective titres were about twice higher in the vaccinated as compared to the non-vaccinated group. There were no statistically significant differences in seroprevalence between seven districts of Vojvodina. Conclusion. The 2009 pandemic influenza A(H1N1v epidemic significantly influenced the herd immunity in our population regardless of low immunization coverage with highest immunity levels in adolescents aged 15-19 years and with similar herd immunity levels in all the regions in the province six months after the outbreak.

Petrovi? Vladimir

2012-01-01

129

Direct association between pharyngeal viral secretion and host cytokine response in severe pandemic influenza  

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Full Text Available Abstract Background Severe disease caused by 2009 pandemic influenza A/H1N1virus is characterized by the presence of hypercytokinemia. The origin of the exacerbated cytokine response is unclear. As observed previously, uncontrolled influenza virus replication could strongly influence cytokine production. The objective of the present study was to evaluate the relationship between host cytokine responses and viral levels in pandemic influenza critically ill patients. Methods Twenty three patients admitted to the ICU with primary viral pneumonia were included in this study. A quantitative PCR based method targeting the M1 influenza gene was developed to quantify pharyngeal viral load. In addition, by using a multiplex based assay, we systematically evaluated host cytokine responses to the viral infection at admission to the ICU. Correlation studies between cytokine levels and viral load were done by calculating the Spearman correlation coefficient. Results Fifteen patients needed of intubation and ventilation, while eight did not need of mechanical ventilation during ICU hospitalization. Viral load in pharyngeal swabs was 300 fold higher in the group of patients with the worst respiratory condition at admission to the ICU. Pharyngeal viral load directly correlated with plasma levels of the pro-inflammatory cytokines IL-6, IL-12p70, IFN-?, the chemotactic factors MIP-1?, GM-CSF, the angiogenic mediator VEGF and also of the immuno-modulatory cytokine IL-1ra (p Conclusions Severe respiratory disease caused by the 2009 pandemic influenza virus is characterized by the existence of a direct association between viral replication and host cytokine response, revealing a potential pathogenic link with the severe disease caused by other influenza subtypes such as H5N1.

Castro Carmen

2011-08-01

130

Optimizing tactics for use of the U.S. Antiviral Strategic National Stockpile for Pandemic (H1N1) Influenza, 2009.  

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Public health agencies across the globe are working to mitigate the impact of the 2009 pandemic caused by swine-origin influenza A (H1N1) virus. Prior to the large-scale distribution of an effective vaccine, the primary modes of control have included careful surveillance, social distancing and hygiene measures, strategic school closures, other community measures, and the prudent use of antiviral medications to prevent infection (prophylaxis) or reduce the severity and duration of symptoms (treatment). Here, we use mathematical models to determine the optimal geo-temporal tactics for distributing the U.S. strategic national stockpile of antivirals for treatment of infected cases during the early stages of a pandemic, prior to the wide availability of vaccines.We present a versatile optimization method for efficiently searching large sets of public health intervention strategies, and apply it to evaluating tactics for distributing antiviral medications from the U.S. Strategic National Stockpile (SNS). We implemented the algorithm on a network model of H1N1 transmission within and among U.S. cities to project the epidemiological impacts of antiviral stockpile distribution schedules and priorities. The resulting optimized strategies critically depend on the rates of antiviral uptake and wastage (through misallocation or loss). And while a surprisingly simple pro rata distribution schedule is competitive with the optimized strategies across a wide range of uptake and wastage, other equally simple policies perform poorly.Even as vaccination campaigns get underway worldwide, antiviral medications continue to play a critical in reducing H1N1-associated morbidity and mortality. If efforts are made to increase the fraction of cases treated promptly with antivirals above current levels, our model suggests that optimal use of the antiviral component of the Strategic National Stockpile may appreciably slow the transmission of H1N1 during fall 2009, thereby improving the impact of targeted vaccination. A more aggressive optimized antiviral strategy of this type may prove critical to mitigating future flu pandemics, but may increase the risk of antiviral resistance. PMID:20029665

Dimitrov, Nedialko; Goll, Sebastian; Hupert, Nathaniel; Pourbohloul, Babak; Meyers, Lauren Ancel

2009-01-01

131

Tropism of Pandemic 2009 H1N1 Influenza a Virus  

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Substitutions at the receptor-binding site of the pandemic H1N1 2009 influenza A virus (H1N1pdm) hemagglutinin (HA) gene may be critical in determining whether a virus binds to human or avian receptors. Previous reports suggest that HA Gly222 and/or Arg223 allow viruses to bind preferentially to the ?2,3-linked sialic acid found in avian species. We also demonstrated that serial passaging of influenza A virus in embryonated chicken eggs increased viral growth 32- to 64-fold, coincident with ...

Ramadhany, Ririn; Yasugi, Mayo; Nakamura, Shota; Daidoji, Tomo; Watanabe, Yohei; Takahashi, Kazuo; Ikuta, Kazuyoshi; Nakaya, Takaaki

2012-01-01

132

Adenovirus-Vectored Vaccine as a Rapid-Response Tool Against Avian Influenza Pandemic  

International Nuclear Information System (INIS)

Influenza viruses in nature undergo genetic mutation and reassortment. Three pandemics of avian influenza in man were recorded in the twentieth century. Highly pathogenic avian influenza (HPAI) viruses currently in circulation pose a threat for another world-wide pandemic, if they become transmissible from man to man. Manufacturing protective vaccines using current egg-based technology is often difficult due to the virulence of the virus and its adverse effects on the embryonating egg substrate. New technologies allow the creation of safe and protective pandemic influenza vaccines without the need for egg based substrates. These technologies allow new vaccines to be created in less than one month. Manufacturing is in tissue culture, not eggs. Vaccine can be administered to man non-invasively, without adjuvants, eliciting a rapid and protective immune response. Protective immunity against avian influenza (AI) virus was elicited in chickens by single-dose in ovo vaccination with a replication-competent adenovirus (RCA)-free human adenovirus serotype 5 (Ad5)-derived vector encoding an H5N9 avian influenza virus hemagglutinin. Vaccinated chickens were protected against both H5N1 and H5N2 HPAI virus challenges. Mass-administration of this bird flu vaccine can be streamlined with available robotic in ovo injectors. Vaccination using this vaccine could protect the the largest host reservoir (chickens) and greatly reduce the exposure of man to avian influenza. In addition, Ad5-vectored vaccines can be produced rapidly and the safety margin of a non-replicating vector is superior to that of a replicating counterpart. Furthermore, this mode of vaccination is compatible with epidemiological surveys of natural AI virus infections. In addition to mass immunization of poultry, both animals and humans have been effectively immunized by intranasal administration of Ad5-vectored influenza vaccines without any appreciable side effects, even in mice and human volunteers with preexisting immunity to Ad5. RCA-free Ad5-vectored AI vaccines may thus provide a critical tool for mitigating an AI pandemic in a simple, rapid, and safe manner. (author)

133

[The influenza pandemic 1968-1970: crisis management in separated Germany - "Vodka and Raspberry Tea"].  

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The Hong Kong Flu in the years 1968-1970 challenged both German health care systems. This article intends to analyse the patterns of reaction to the pandemic. Both German states faced the threat according to their respective ideological orientation. This applied to the two parts of Berlin - West and East - as well. In the GDR the control of influenza was centrally organized. When the pandemic passed away an influenza guiding document ("Führungsdokument") was made obligatory for the fight against the plague. In the FRG hospital treatment maintained predominance while the outpatient sector was administrated by physicians in private practice. In West- Berlin outpatient clinics were declined by the Association of Physicians ("Kassenärztliche Vereinigung"). In 1970 a first concept of surveillance was presented on the level of the state in West Germany. In the years 1968-1970 vaccinations were not common in both German states. The essay is based on the analysis of archival sources, monographs, scientific and newspaper articles. PMID:22169920

Witte, W

2011-12-01

134

Use of antiviral agents and other measures in an influenza pandemic.  

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The Dutch Ministry of Health asked the Health Council for advice on how to prepare for a possible influenza pandemic. In two advisory reports the Committee responsible indicated the measures that it believes would need to be taken if such a pandemic were to reach the Netherlands. During a pandemic, the Committee recommends that every resident of the Netherlands with influenza-like illness should be treated with neuraminidase inhibitors such as antiviral agents. This approach serves to mitigate the course of the disease, to reduce infectivity and to allow patients to build up immunity to the virus. Since up to 30% of the population could become ill, the Committee anticipates that a stock of five million courses of the neuraminidase inhibitor oseltamivir is sufficient. If a pandemic were to occur at a time that the stock does not exceed the present 225,000 courses, the committee advises restricting treatment to three specified groups of patients. If the first few patients are traced shortly after they fall ill, the Committee recommends treatment of the patient and postexposure prophylaxis for his/her close contacts. The Committee does not advocate prophylaxis in general, but it can envisage prophylaxis for particular groups of patients or under particular circumstances. The Committee believes that in order to reduce rapid spread of the virus, schools should be closed and events where large numbers of people gather in a confined space should be cancelled. Because this recommendation would have major social and economic consequences, the Committee understands that its implication will depend on the anticipated severity and extent of the pandemic. The Committee regards vaccination against influenza as the best means of protecting the population. The development of a vaccine should be the absolute priority. PMID:16244380

Groeneveld, K; van der Noordaa, J

2005-10-01

135

Genesis and pathogenesis of the 1918 pandemic H1N1 influenza A virus.  

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The source, timing, and geographical origin of the 1918-1920 pandemic influenza A virus have remained tenaciously obscure for nearly a century, as have the reasons for its unusual severity among young adults. Here, we reconstruct the origins of the pandemic virus and the classic swine influenza and (postpandemic) seasonal H1N1 lineages using a host-specific molecular clock approach that is demonstrably more accurate than previous methods. Our results suggest that the 1918 pandemic virus originated shortly before 1918 when a human H1 virus, which we infer emerged before ?1907, acquired avian N1 neuraminidase and internal protein genes. We find that the resulting pandemic virus jumped directly to swine but was likely displaced in humans by ?1922 by a reassortant with an antigenically distinct H1 HA. Hence, although the swine lineage was a direct descendent of the pandemic virus, the post-1918 seasonal H1N1 lineage evidently was not, at least for HA. These findings help resolve several seemingly disparate observations from 20th century influenza epidemiology, seroarcheology, and immunology. The phylogenetic results, combined with these other lines of evidence, suggest that the high mortality in 1918 among adults aged ?20 to ?40 y may have been due primarily to their childhood exposure to a doubly heterosubtypic putative H3N8 virus, which we estimate circulated from ?1889-1900. All other age groups (except immunologically naive infants) were likely partially protected by childhood exposure to N1 and/or H1-related antigens. Similar processes may underlie age-specific mortality differences between seasonal H1N1 vs. H3N2 and human H5N1 vs. H7N9 infections. PMID:24778238

Worobey, Michael; Han, Guan-Zhu; Rambaut, Andrew

2014-06-01

136

Prolonged shedding of pandemic influenza A (H1N1) 2009 virus in a pancreas-after-kidney transplant recipient.  

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Prolonged shedding of influenza virus has been reported in immunocompromised patients. Delayed viral clearance may contribute to antiviral resistance and nosocomial transmission. We report a case of a pancreas-after-kidney transplant recipient who had detectable pandemic influenza A virus for 12 months. Pyrosequencing analysis detected the H275Y mutation, which is associated with resistance to oseltamivir. PMID:25081940

Bruminhent, Jackrapong; Deziel, Paul J; Wotton, Jason T; Binnicker, Matthew J; Razonable, Raymund R

2014-10-01

137

Key transmission parameters of an institutional outbreak during the 1918 influenza pandemic estimated by mathematical modelling  

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Abstract Aim To estimate the key transmission parameters associated with an outbreak of pandemic influenza in an institutional setting (New Zealand 1918). Methods Historical morbidity and mortality data were obtained from the report of the medical officer for a large military camp. A susceptible-exposed-infectious-recovered epidemiological model was solved numerically to find a range of best-fit estimates for key epidemic parameters and an incidence curve. Morta...

Nelson Peter; Baker Michael; Wilson Nick; Sertsou Gabriel; Roberts Mick G

2006-01-01

138

[Establishment of a mouse-lethal model for pandemic H1N1 influenza virus].  

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To establish the mouse-lethal model for pandemic H1N1 influenza virus, provide an animal model for studying the pathogenicity and host adaptation of 2009 pandemic H1N1 influenza virus, and find out the key amino acid mutations which may affect viral virulence and replication. A pandemic H1N1 influenza virus strain, A/Sichuan/SWL1/2009 (H1N1, SC/1) was passaged in mouse lung by 15 cycles with intranasal infection. The passaged viruses were all propagated in MDCK cells and sequenced. Based on the sequencing results, four mice in each group were inoculated with 6 selected viruses and their weight and survival rate were monitored during the following 14 days after infection. Additionally, SC/1-MA P14 and P15 viruses were sequenced after purification by Plague Assay. Viral virulence was increased after serial passages and the mortality of 100% was detected after 7 passages. Several amino acid residue mutations of passaged viruses which may contribute to the enhanced virulence were observed. The increased virulence of passaged viruses and mammalian host adaptation maybe associated with amino acid mutations in viral functional proteins. Finally, we established a mouse-lethal model. PMID:21528533

Zhu, Yun; Liu, Li-qi; Zhou, Jian-fang; Zhu, Wen-fei; Qin, Kun; Yu, Zai-jiang; Wang, Da-yan; Zhao, Xiang; Li, Xi-yan; Lan, Yu; Shu, Yue-long

2011-03-01

139

Prevalence of influenza-like illness and seasonal and pandemic H1N1 influenza vaccination coverage among workers--United States, 2009-10 influenza season.  

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During an influenza pandemic, information about the industry and occupation (I&O) of persons likely to be infected with influenza virus is important to guide key policy decisions regarding vaccine prioritization and exposure-control measures. Health-care personnel (HCP) might have increased opportunity for exposure to influenza infection, and they have been prioritized for influenza vaccination because of their own risk and the risk that infected HCP pose to patients. To identify other groups of workers that might be at increased risk for pandemic influenza infection, influenza-like illness (ILI) and vaccination coverage data from the 2009 National H1N1 Flu Survey (NHFS), which was conducted during October 2009 through June 2010, were analyzed. In a representative sample of 28,710 employed adults, 5.5% reported ILI symptoms in the month before the interview, and 23.7% received the 2009 pandemic H1N1 (pH1N1) influenza vaccine. Among employed adults, the highest prevalence of ILI was reported by those employed in the industry groups "Real estate and rental and leasing" (10.5%) and "Accommodation and food services" (10.2%), and in the occupation groups "Food preparation and serving related" (11.0%) and "Community and social services" (8.3%). Both seasonal influenza and pH1N1 vaccination coverage were relatively low in all of these groups of workers. Adults not in the labor force (i.e., homemakers, students, retired persons, and persons unable to work) had ILI prevalence and pH1N1 vaccination coverage similar to those found in all employed adults combined; in contrast, ILI prevalence was higher and pH1N1 vaccination coverage was lower among unemployed adults (i.e., those looking for work). These results suggest that adults employed in certain industries and occupations might have increased risk for influenza infection, and that the majority of these workers did not receive seasonal or pH1N1 influenza vaccine. Unemployed adults might also be considered a high risk group for influenza. PMID:24622286

Luckhaupt, Sara E; Calvert, Geoffrey M; Li, Jia; Sweeney, Marie; Santibanez, Tammy A

2014-03-14

140

Viral shedding in children infected by pandemic A/H1N1/2009 influenza virus  

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Full Text Available Abstract Background The aim of this study was to investigate viral shedding in otherwise healthy children with pandemic A/H1N1/2009 influenza in order to define how long children with pandemic A/H1N1/2009 influenza shed the virus, and also plan adequate measures to control the spread of the disease within households. Findings In 74 otherwise healthy children with pandemic A/H1N1/2009 influenza, nasopharyngeal swabs were taken for virus detection upon hospital admission and every two days until negative. The nasopharyngeal swabs of all of the children were positive for pandemic A/H1N1/2009 influenza virus in the first three days after the onset of infection, and only 21.6% and 13.5% remained positive after respectively 11 and 15 days. No child was positive after more than 15 days. Viral load also decreased over time, and was not associated with patient age or the risk of pneumonia. Those who shed the virus for ? 9 days were not at any increased risk of suffering from more severe disease in comparison with those who shed the virus for a shorter time, but their households experienced a significantly higher number of influenza-like illness during the two weeks after the onset of the initial disease (72.3% vs 41.4%; p Conclusions Regardless of their age, healthy children can shed pandemic A/H1N1/2009 influenza virus for up to two weeks after illness onset, and the households of the children who shed the virus for ? 9 days suffered a higher number of influenza-like illness in the two weeks following the onset of the first disease. This could suggest that when a completely unknown influenza virus is circulating, isolation period of infected children has to be longer than the 7 days recommended for the infections due to seasonal influenza viruses.

Fossali Emilio

2011-07-01

 
 
 
 
141

Examining the knowledge, attitudes and practices of domestic and international university students towards seasonal and pandemic influenza  

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Full Text Available Abstract Background Prior to the availability of the specific pandemic vaccine, strategies to mitigate the impact of the disease typically involved antiviral treatment and “non-pharmaceutical” community interventions. However, compliance with these strategies is linked to risk perceptions, perceived severity and perceived effectiveness of the strategies. In 2010, we undertook a study to examine the knowledge, attitudes, risk perceptions, practices and barriers towards influenza and infection control strategies amongst domestic and international university students. Methods A study using qualitative methods that incorporated 20 semi-structured interviews was undertaken with domestic and international undergraduate and postgraduate university students based at one university in Sydney, Australia. Participants were invited to discuss their perceptions of influenza (seasonal vs. pandemic in terms of perceived severity and impact, and attitudes towards infection control measures including hand-washing and the use of social distancing, isolation or cough etiquette. Results While participants were generally knowledgeable about influenza transmission, they were unable to accurately define what ‘pandemic influenza’ meant. While avian flu or SARS were mistaken as examples of past pandemics, almost all participants were able to associate the recent “swine flu” situation as an example of a pandemic event. Not surprisingly, it was uncommon for participants to identify university students as being at risk of catching pandemic influenza. Amongst those interviewed, it was felt that ‘students’ were capable of fighting off any illness. The participant’s nominated hand washing as the most feasible and acceptable compared with social distancing and mask use. Conclusions Given the high levels of interaction that occurs in a university setting, it is really important that students are informed about disease transmission and about risk of infection. It may be necessary to emphasize that pandemic influenza could pose a real threat to them, that it is important to protect oneself from infection and that infection control measures can be effective.

Seale Holly

2012-04-01

142

Influenza pandémica A (H1N1 2009: epidemiología, características clínicas y diferencias con influenza estacional en Chile Pandemic influenza A (H1N1 2009: epidemiology, clinical features and differences with seasonal influenza in Chile  

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Full Text Available La pandemia de inluenza A (H1N1 2009 generó preguntas sobre sus diferencias con influenza estacional. Objetivos: Describir las características de influenza pandémica y comparar con influenza estacional. Pacientes y Métodos: Estudio descriptivo de casos confirmados de influenza pandémica en adultos internados en el Hospital Clínico de la Pontificia Universidad Católica entre mayo y julio de 2009, comparado con 95 casos históricos de influenza estacional. Resultados: 54 pacientes con influenza pandémica, 51,9% género masculino, edad 52,8 ± 19,5 años; 79,6% presentaban co-morbilidades; 16,7% inmunocomprometidos, 7,4% mujeres embarazadas, 25,9% de adquisición nosocomial, 31,5% requirió cuidados intensivos/intermedios. Se diagnosticó neumonía en 37% y la mortalidad global fue 3,7%. En la comparación con inluenza estacional, la pandémica afectó menos pacientes > de 65 años (31,5 vs 68%, p Pandemic influenza A (H1N1 2009 raised questions regarding differences with seasonal influenza. Objectives: To describe the clinical features of pandemic influenza and compare them to seasonal influenza. Patients y Methods: A descriptive study that compared hospitalized adults was done between patients with confirmed pandemic inluenza in the Hospital Clínico Universidad Católica in Santiago, Chile, from May to July 2009 and 95 confirmed historic cases of seasonal influenza. Results: 54 patients with pandemic influenza were included, 51.9% were male, age of 52.8 ± 19.5 years old; 79.6% had chronic diseases; 16.7% were immunocompromised patients and 7.4% of pregnant women. 25.9% of the patients acquired the infection during the hospitalization. 31.5% were admitted to intermediate/intensive care units. Pneumonia was diagnosed in 37%, and the mortality rate was 3.7%. The comparison between pandemic and seasonal influenza showed less proportion of patient > 65 years of age (31.5% vs. 68%; p < 0.0001; double number of nosocomial acquisition and more cases of pneumonia and death. Conclusions: The pandemic inluenza infection affected younger people and was related with more nosocomial cases, pneumonia and mortality rates than seasonal inluenza.

Ricardo Rabagliati B

2011-12-01

143

Knowledge and attitudes of university students toward pandemic influenza: a cross-sectional study from Turkey  

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Full Text Available Abstract Background During an influenza pandemic, higher education institutions with large populations of young adults can become serious outbreak centers. Since outbreak management is essential to disease control, we aimed to examine university students' knowledge of and attitudes toward the pandemic influenza A/H1N1 and vaccination and other preventive measures. Methods A cross-sectional study was conducted among 402 first year university students at Yeditepe University in Istanbul, Turkey between 1st and 30th of November 2009. Data regarding socio-demographic characteristics of the students, perceptions, level of knowledge and attitudes toward influenza pandemic and prevention measures were collected by means of a self-administered questionnaire. The questionnaire was distributed by the students affiliated with SANITAS, a university club of students in health related sciences. Results 25.1% (101/402 of the study group perceived their personal risk of influenza as "high", while 40.5% (163/402 perceived it as "moderate", 20.6% (107/402 viewed it as "low" and 7.7% (31/402 indicated that it was "unknown". The risk perception of males was significantly lower than that of females (p = 0.004 and the risk perception among the students of health sciences was significantly lower than that of students of other sciences (p = 0.037. Within the study group, 72.1% (290/402 indicated that their main information source regarding H1N1 was the mass media. Health sciences students tended to rely more on the internet as an information source than other students (p = 0.015. The vast majority (92.8%; 373/402 of those interviewed indicated that they would not be vaccinated. The major concerns regarding vaccination had to do with the safety and side effects of the vaccine. Most of the participants (343/402, 85.3% were carrying out one of prevention measures and the vast majority believed that hand washing, face mask and quarantina were effective measures for prevention. Conclusion The participants had enough knowledge about H1N1 pandemic about the disease although there were still gaps and confusions in some areas. In the future, when planning management strategies regarding pandemics or outbreaks in higher education institutions, new strategies should be developed to promote positive health behaviour among university students compatible with the international guidelines. Main information source is mass media, so it seems that new policies must be developed to attract attention of students to use different and more scientific-based information sources.

Hayran Osman

2010-07-01

144

Estimating the costs of school closure for mitigating an influenza pandemic  

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Full Text Available Abstract Background School closure is a key component of many countries' plans to mitigate the effect of an influenza pandemic. Although a number of studies have suggested that such a policy might reduce the incidence, there are no published studies of the cost of such policies. This study attempts to fill this knowledge gap Methods School closure is expected to lead to significant work absenteeism of working parents who are likely to be the main care givers to their dependent children at home. The cost of absenteeism due to school closure is calculated as the paid productivity loss of parental absenteeism during the period of school closure. The cost is estimated from societal perspective using a nationally representative survey. Results The results show that overall about 16% of the workforce is likely to be the main caregiver for dependent children and therefore likely to take absenteeism. This rises to 30% in the health and social care sector, as a large proportion of the workforce are women. The estimated costs of school closure are significant, at £0.2 bn – £1.2 bn per week. School closure is likely to significantly exacerbate the pressures on the health system through staff absenteeism. Conclusion The estimates of school closure associated absenteeism and the projected cost would be useful for pandemic planning for business continuity, and for cost effectiveness evaluation of different pandemic influenza mitigation strategies.

Adams Elisabeth J

2008-04-01

145

Differences in pandemic influenza vaccination policies for pregnant women in Europe  

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Full Text Available Abstract Background An important component of the policy to deal with the H1N1 pandemic in 2009 was to develop and implement vaccination. Since pregnant women were found to be at particular risk of severe morbidity and mortality, the World Health Organization and the European Centers for Disease Control advised vaccinating pregnant women, regardless of trimester of pregnancy. This study reports a survey of vaccination policies for pregnant women in European countries. Methods Questionnaires were sent to European competent authorities of 27 countries via the European Medicines Agency and to leaders of registries of European Surveillance of Congenital Anomalies in 21 countries. Results Replies were received for 24 out of 32 European countries of which 20 had an official pandemic vaccination policy. These 20 countries all had a policy targeting pregnant women. For two of the four countries without official pandemic vaccination policies, some vaccination of pregnant women took place. In 12 out of 20 countries the policy was to vaccinate only second and third trimester pregnant women and in 8 out of 20 countries the policy was to vaccinate pregnant women regardless of trimester of pregnancy. Seven different vaccines were used for pregnant women, of which four contained adjuvants. Few countries had mechanisms to monitor the number of vaccinations given specifically to pregnant women over time. Vaccination uptake varied. Conclusions Differences in pandemic vaccination policy and practice might relate to variation in perception of vaccine efficacy and safety, operational issues related to vaccine manufacturing and procurement, and vaccination campaign systems. Increased monitoring of pandemic influenza vaccine coverage of pregnant women is recommended to enable evaluation of the vaccine safety in pregnancy and pandemic vaccination campaign effectiveness.

Marnoch Gordon J

2011-10-01

146

Age-Specific Mortality During the 1918 Influenza Pandemic: Unravelling the Mystery of High Young Adult Mortality  

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The worldwide spread of a novel influenza A (H1N1) virus in 2009 showed that influenza remains a significant health threat, even for individuals in the prime of life. This paper focuses on the unusually high young adult mortality observed during the Spanish flu pandemic of 1918. Using historical records from Canada and the U.S., we report a peak of mortality at the exact age of 28 during the pandemic and argue that this increased mortality resulted from an early life exposure to influenza during the previous Russian flu pandemic of 1889–90. We posit that in specific instances, development of immunological memory to an influenza virus strain in early life may lead to a dysregulated immune response to antigenically novel strains encountered in later life, thereby increasing the risk of death. Exposure during critical periods of development could also create holes in the T cell repertoire and impair fetal maturation in general, thereby increasing mortality from infectious diseases later in life. Knowledge of the age-pattern of susceptibility to mortality from influenza could improve crisis management during future influenza pandemics. PMID:23940526

Gagnon, Alain; Miller, Matthew S.; Hallman, Stacey A.; Bourbeau, Robert; Herring, D. Ann; Earn, David JD.; Madrenas, Joaquin

2013-01-01

147

Continued dominance of pandemic A(H1N1 2009 influenza in Victoria, Australia in 2010  

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Full Text Available The 2010 Victorian influenza season was characterized by normal seasonal influenza activity and the dominance of the pandemic A(H1N1 2009 strain. General Practice Sentinel Surveillance rates peaked at 9.4 ILI cases per 1000 consultations in week 36 for metropolitan practices, and at 10.5 ILI cases per 1000 in the following week for rural practices. Of the 678 ILI cases, 23% were vaccinated, a significantly higher percentage than in previous years. A significantly higher percentage of ILI patients were swabbed in 2010 compared to 2003–2008, but similar to 2009, with a similar percentage being positive for influenza as in previous years. Vaccination rates increased with patient age. Melbourne Medical Deputising Service rates peaked in week 35 at 19.1 ILI cases per 1000 consultations. Of the 1914 cases of influenza notified to the Department of Health, Victoria, 1812 (95% were influenza A infections - 1001 (55% pandemic A(H1N1 2009, 4 (<1% A(H3N2 and 807 (45% not subtyped; 88 (5% were influenza B; and 14 (< 1% were influenza A and B co-infections. The World Health Organization Collaborating Centre for Reference and Research on Influenza tested 403 isolates of which 261 were positive for influenza, 250 of which were influenza A and 11 were influenza B. Ninety-two per cent of the influenza A viruses were pandemic A(H1N1 2009, and following antigenic analysis all of these were found to be similar to the current vaccine strain. Three viruses (0.9% were found to be oseltamivir resistant due to an H275Y mutation in the neuraminidase gene.

James E. Fielding

2011-08-01

148

The Effects of School Closures on Influenza Outbreaks and Pandemics: Systematic Review of Simulation Studies  

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Background School closure is a potential intervention during an influenza pandemic and has been investigated in many modelling studies. Objectives To systematically review the effects of school closure on influenza outbreaks as predicted by simulation studies. Methods We searched Medline and Embase for relevant modelling studies published by the end of October 2012, and handsearched key journals. We summarised the predicted effects of school closure on the peak and cumulative attack rates and the duration of the epidemic. We investigated how these predictions depended on the basic reproduction number, the timing and duration of closure and the assumed effects of school closures on contact patterns. Results School closures were usually predicted to be most effective if they caused large reductions in contact, if transmissibility was low (e.g. a basic reproduction number predictions varied (e.g. reductions in the peak were frequently 20–60% but some studies predicted >90% reductions or even increases under certain assumptions). This partly reflected differences in model assumptions, such as those regarding population contact patterns. Conclusions Simulation studies suggest that school closure can be a useful control measure during an influenza pandemic, particularly for reducing peak demand on health services. However, it is difficult to accurately quantify the likely benefits. Further studies of the effects of reactive school closures on contact patterns are needed to improve the accuracy of model predictions. PMID:24830407

Jackson, Charlotte; Mangtani, Punam; Hawker, Jeremy; Olowokure, Babatunde; Vynnycky, Emilia

2014-01-01

149

Key transmission parameters of an institutional outbreak during the 1918 influenza pandemic estimated by mathematical modelling  

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Full Text Available Abstract Aim To estimate the key transmission parameters associated with an outbreak of pandemic influenza in an institutional setting (New Zealand 1918. Methods Historical morbidity and mortality data were obtained from the report of the medical officer for a large military camp. A susceptible-exposed-infectious-recovered epidemiological model was solved numerically to find a range of best-fit estimates for key epidemic parameters and an incidence curve. Mortality data were subsequently modelled by performing a convolution of incidence distribution with a best-fit incidence-mortality lag distribution. Results Basic reproduction number (R0 values for three possible scenarios ranged between 1.3, and 3.1, and corresponding average latent period and infectious period estimates ranged between 0.7 and 1.3 days, and 0.2 and 0.3 days respectively. The mean and median best-estimate incidence-mortality lag periods were 6.9 and 6.6 days respectively. This delay is consistent with secondary bacterial pneumonia being a relatively important cause of death in this predominantly young male population. Conclusion These R0 estimates are broadly consistent with others made for the 1918 influenza pandemic and are not particularly large relative to some other infectious diseases. This finding suggests that if a novel influenza strain of similar virulence emerged then it could potentially be controlled through the prompt use of major public health measures.

Nelson Peter

2006-11-01

150

Pandemic influenza A/H1N1: comparative analysis of microscopic lung histopathological findings  

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Full Text Available Objective: To analyze the histopathological lung findings of four fatal cases of the 2009 H1N1 influenza pandemic and their correlation with clinical and epidemiological characteristics. Methods: descriptive data from medical records of four patients who died in the Intensive Care Unit of a university hospital in 2009. Nasopharyngeal aspirate specimens were collected from the patients and were analyzed by real-time polymerase chain reaction. Lung biopsy was performed post mortem; a score of intensity for pathological changes was applied. Results: Three patients had positive real-time polymerase chain reaction (although all of them had a clinical diagnose of influenza H1N1. The main histopathological changes were: exudative diffuse alveolar damage with atelectasis; varying degrees of alveolar hemorrhage and edema, necrosis and sloughing of the respiratory epithelium in several bronchioli; and thrombus formation. One of the patients (the pregnant one presented histopathological findings of cytomegalic inclusion. Conclusion: The pulmonary histopathological findings in patients with fatal 2009 H1N1 influenza pandemic disclosed intense alveolar damage and hemorrhage and severebronchiolitis. A co-infection with cytomegalovirus was described inthe pregnant patient.

Roberta Marchiori

2012-09-01

151

An SIR Estimation for Pandemic by influenza A During the Haj  

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Full Text Available In this study, a system of SIR models depended on effective contact rate of the disease and potential size of the community is developed for simulating patterns of pandemic by influenza A during the Haj. Indeed, we consider three different SIR models such that each of them is calibrated to simulate a separate part of the ceremony and then we link these models together to obtain system simulating whole the Haj ceremony. Considering different numerical values of effective contact rate and potential size of the community, we estimate the portion of susceptible hosts in the community and also the portion of total infection during the ceremony and portion of infective individuals at any time of the ceremony. Our goal is to suggest doable optimal situations keeping the pandemic under the control and the number of infected people as low as possible.

O. Rabiei Motlagh

2010-01-01

152

Influenza C virus surveillance during the first influenza A (H1N1) 2009 pandemic wave in Catalonia, Spain.  

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Although particular attention is paid to influenza A and B virus isolates during influenza surveillance, influenza C virus (FLUCV) coexisted during the first influenza A (H1N1) 2009 pandemic wave during the 2009-2010 season. From 27 April 2009 to 9 May 2010, 12 strains of FLUCV were detected in specimens collected from 1713 nonhospitalized patients with upper respiratory tract illness using a molecular method. Half of the patients with FLUCV infection were older than 14 years. The most frequent symptoms were cough and fever, similar to other viral respiratory infections. Phylogenetic analysis of the hemagglutinin-esterase gene revealed that the strains belonged to the C/Kanagawa/1/76-related and C/Sao Paulo/378/82-related lineages, demonstrating their co-circulation in Catalonia. In addition to regular virological surveillance that provides information about the incidence and the exact role of FLUCV in acute viral respiratory infections in the general population, the genetic lineage identification offers additional data for epidemiological purposes. PMID:21396539

Antón, Andrés; Marcos, María A; Codoñer, Francisco M; de Molina, Patricia; Martínez, Anna; Cardeñosa, Neus; Godoy, Pere; Torner, Nuria; Martínez, Miguel J; Ramón, Susana; Tudó, Griselda; Isanta, Ricard; Gonzalo, Verónica; de Anta, María T Jiménez; Pumarola, Tomàs

2011-04-01

153

Epidemiological characteristics of the influenza A(H1N1 2009 pandemic in the Western Pacific Region  

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Full Text Available The first laboratory-confirmed cases of infection with pandemic influenza A(H1N1 2009 in the Western Pacific Region were reported on 28 April 2009. By 11 June 2009, the day the pandemic was declared by the World Health Organization, nine Western Pacific Region countries and areas had reported laboratory-confirmed pandemic influenza A(H1N1 2009 cases. From April 2009 to July 2010, more than 250 000 cases and 1800 deaths from laboratory-confirmed pandemic influenza A(H1N1 2009 were reported from 34 countries and areas in the Region. By age group region-wide, 8.6%, 41.9%, 48.3%, and 1.2% of cases were in the < 5 years, 5–14 years, 15–64 years, and 65+ years age groups, respectively; the overall crude case fatality ratio in the Western Pacific Region was 0.5%. The pandemic demonstrated that region-wide disease reporting was possible. Countries and areas of the Western Pacific Region should take this opportunity to strengthen the systems established during the pandemic to develop routine disease reporting.

Lisa McCallum

2010-12-01

154

Healthcare workers as parents: attitudes toward vaccinating their children against pandemic influenza A/H1N1  

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Full Text Available Abstract Background Both the health care workers (HCWs and children are target groups for pandemic influenza vaccination. The coverage of the target populations is an important determinant for impact of mass vaccination. The objective of this study is to determine the attitudes of HCWs as parents, toward vaccinating their children with pandemic influenza A/H1N1 vaccine. Methods A cross-sectional questionnaire survey was conducted with health care workers (HCWs in a public hospital during December 2009 in Istanbul. All persons employed in the hospital with or without a health-care occupation are accepted as HCW. The HCWs who are parents of children 6 months to 18 years of age were included in the study. Pearson's chi-square test and logistic regression analysis was applied for the statistical analyses. Results A total of 389 HCWs who were parents of children aged 6 months-18 years participated study. Among all participants 27.0% (n = 105 reported that themselves had been vaccinated against pandemic influenza A/H1N1. Two third (66.1% of the parents answered that they will not vaccinate their children, 21.1% already vaccinated and 12.9% were still undecided. Concern about side effect was most reported reason among who had been not vaccinated their children and among undecided parents. The second reason for refusing the pandemic vaccine was concerns efficacy of the vaccine. Media was the only source of information about pandemic influenza in nearly one third of HCWs. Agreement with vaccine safety, self receipt of pandemic influenza A/H1N1 vaccine, and trust in Ministry of Health were found to be associated with the positive attitude toward vaccinating their children against pandemic influenza A/H1N1. Conclusions Persuading parents to accept a new vaccine seems not be easy even if they are HCWs. In order to overcome the barriers among HCWs related to pandemic vaccines, determination of their misinformation, attitudes and behaviors regarding the pandemic influenza vaccination is necessary. Efforts for orienting the HCWs to use evidence based scientific sources, rather than the media for information should be considered by the authorities.

Torun Fuat

2010-10-01

155

Influenza pandemic intervention planning using InfluSim: pharmaceutical and non- pharmaceutical interventions  

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Full Text Available Abstract Background Influenza pandemic preparedness plans are currently developed and refined on national and international levels. Much attention has been given to the administration of antiviral drugs, but contact reduction can also be an effective part of mitigation strategies and has the advantage to be not limited per se. The effectiveness of these interventions depends on various factors which must be explored by sensitivity analyses, based on mathematical models. Methods We use the freely available planning tool InfluSim to investigate how pharmaceutical and non-pharmaceutical interventions can mitigate an influenza pandemic. In particular, we examine how intervention schedules, restricted stockpiles and contact reduction (social distancing measures and isolation of cases determine the course of a pandemic wave and the success of interventions. Results A timely application of antiviral drugs combined with a quick implementation of contact reduction measures is required to substantially protract the peak of the epidemic and reduce its height. Delays in the initiation of antiviral treatment (e.g. because of parsimonious use of a limited stockpile result in much more pessimistic outcomes and can even lead to the paradoxical effect that the stockpile is depleted earlier compared to early distribution of antiviral drugs. Conclusion Pharmaceutical and non-pharmaceutical measures should not be used exclusively. The protraction of the pandemic wave is essential to win time while waiting for vaccine development and production. However, it is the height of the peak of an epidemic which can easily overtax general practitioners, hospitals or even whole public health systems, causing bottlenecks in basic and emergency medical care.

Schwehm Markus

2007-07-01

156

Influenza pandémica A (H1N1) 2009: epidemiología, características clínicas y diferencias con influenza estacional en Chile / Pandemic influenza A (H1N1) 2009: epidemiology, clinical features and differences with seasonal influenza in Chile  

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Full Text Available SciELO Chile | Language: Spanish Abstract in spanish La pandemia de inluenza A (H1N1) 2009 generó preguntas sobre sus diferencias con influenza estacional. Objetivos: Describir las características de influenza pandémica y comparar con influenza estacional. Pacientes y Métodos: Estudio descriptivo de casos confirmados de influenza pandémica en adultos [...] internados en el Hospital Clínico de la Pontificia Universidad Católica entre mayo y julio de 2009, comparado con 95 casos históricos de influenza estacional. Resultados: 54 pacientes con influenza pandémica, 51,9% género masculino, edad 52,8 ± 19,5 años; 79,6% presentaban co-morbilidades; 16,7% inmunocomprometidos, 7,4% mujeres embarazadas, 25,9% de adquisición nosocomial, 31,5% requirió cuidados intensivos/intermedios. Se diagnosticó neumonía en 37% y la mortalidad global fue 3,7%. En la comparación con inluenza estacional, la pandémica afectó menos pacientes > de 65 años (31,5 vs 68%, p Abstract in english Pandemic influenza A (H1N1) 2009 raised questions regarding differences with seasonal influenza. Objectives: To describe the clinical features of pandemic influenza and compare them to seasonal influenza. Patients y Methods: A descriptive study that compared hospitalized adults was done between pati [...] ents with confirmed pandemic inluenza in the Hospital Clínico Universidad Católica in Santiago, Chile, from May to July 2009 and 95 confirmed historic cases of seasonal influenza. Results: 54 patients with pandemic influenza were included, 51.9% were male, age of 52.8 ± 19.5 years old; 79.6% had chronic diseases; 16.7% were immunocompromised patients and 7.4% of pregnant women. 25.9% of the patients acquired the infection during the hospitalization. 31.5% were admitted to intermediate/intensive care units. Pneumonia was diagnosed in 37%, and the mortality rate was 3.7%. The comparison between pandemic and seasonal influenza showed less proportion of patient > 65 years of age (31.5% vs. 68%; p

Ricardo, Rabagliati B; Leonardo, Siri Z; Carlos M, Pérez C; Jaime, Labarca L; Marcela, Ferrés G.

157

Time variations in the transmissibility of pandemic influenza in Prussia, Germany, from 1918–19  

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Full Text Available Abstract Background Time variations in transmission potential have rarely been examined with regard to pandemic influenza. This paper reanalyzes the temporal distribution of pandemic influenza in Prussia, Germany, from 1918–19 using the daily numbers of deaths, which totaled 8911 from 29 September 1918 to 1 February 1919, and the distribution of the time delay from onset to death in order to estimate the effective reproduction number, Rt, defined as the actual average number of secondary cases per primary case at a given time. Results A discrete-time branching process was applied to back-calculated incidence data, assuming three different serial intervals (i.e. 1, 3 and 5 days. The estimated reproduction numbers exhibited a clear association between the estimates and choice of serial interval; i.e. the longer the assumed serial interval, the higher the reproduction number. Moreover, the estimated reproduction numbers did not decline monotonically with time, indicating that the patterns of secondary transmission varied with time. These tendencies are consistent with the differences in estimates of the reproduction number of pandemic influenza in recent studies; high estimates probably originate from a long serial interval and a model assumption about transmission rate that takes no account of time variation and is applied to the entire epidemic curve. Conclusion The present findings suggest that in order to offer robust assessments it is critically important to clarify in detail the natural history of a disease (e.g. including the serial interval as well as heterogeneous patterns of transmission. In addition, given that human contact behavior probably influences transmissibility, individual countermeasures (e.g. household quarantine and mask-wearing need to be explored to construct effective non-pharmaceutical interventions.

Nishiura Hiroshi

2007-06-01

158

Transmission of a 2009 H1N1 Pandemic Influenza Virus Occurs before Fever Is Detected, in the Ferret Model  

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During the early phase of the 2009 influenza pandemic, attempts were made to contain the spread of the virus. Success of reactive control measures may be compromised if the proportion of transmission that occurs before overt clinical symptoms develop is high. In this study we investigated the timing of transmission of an early prototypic strain of pandemic H1N1 2009 influenza virus in the ferret model. Ferrets are the only animal model in which this can be assessed because they display typica...

Roberts, Kim L.; Shelton, Holly; Stilwell, Peter; Barclay, Wendy S.

2012-01-01

159

Reviewing lessons learnt of SARS in Singapore during planning for influenza pandemic.  

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There were many lessons learnt in Singapore's fight against SARS, and they have proven to be all the more important in our preparations for an influenza pandemic. The following lessons are discussed in this paper including: the widespread ramifications among the various sectors in Singapore (individuals, organizations, community and economy), the first principles of outbreak response, need for enhanced infectious disease control measures, high demands on the healthcare system, the role of management policies implementation and dissemination, multidisciplinary involvement, importance of communication, and business continuity planning. PMID:17312704

Chan, Gregory C T; Koh, D

2006-01-01

160

Antiviral resistance during pandemic influenza: implications for stockpiling and drug use  

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Full Text Available Abstract Background The anticipated extent of antiviral use during an influenza pandemic can have adverse consequences for the development of drug resistance and rationing of limited stockpiles. The strategic use of drugs is therefore a major public health concern in planning for effective pandemic responses. Methods We employed a mathematical model that includes both sensitive and resistant strains of a virus with pandemic potential, and applies antiviral drugs for treatment of clinical infections. Using estimated parameters in the published literature, the model was simulated for various sizes of stockpiles to evaluate the outcome of different antiviral strategies. Results We demonstrated that the emergence of highly transmissible resistant strains has no significant impact on the use of available stockpiles if treatment is maintained at low levels or the reproduction number of the sensitive strain is sufficiently high. However, moderate to high treatment levels can result in a more rapid depletion of stockpiles, leading to run-out, by promoting wide-spread drug resistance. We applied an antiviral strategy that delays the onset of aggressive treatment for a certain amount of time after the onset of the outbreak. Our results show that if high treatment levels are enforced too early during the outbreak, a second wave of infections can potentially occur with a substantially larger magnitude. However, a timely implementation of wide-scale treatment can prevent resistance spread in the population, and minimize the final size of the pandemic. Conclusion Our results reveal that conservative treatment levels during the early stages of the outbreak, followed by a timely increase in the scale of drug-use, will offer an effective strategy to manage drug resistance in the population and avoid run-out. For a 1918-like strain, the findings suggest that pandemic plans should consider stockpiling antiviral drugs to cover at least 20% of the population.

Bowman Christopher S

2009-01-01

 
 
 
 
161

A model for the spread and control of pandemic influenza in an isolated geographical region.  

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In the event of an influenza pandemic, the most probable way in which the virus would be introduced to an isolated geographical area is by an infected traveller. We use a mathematical model, structured on the location at which infection occurs and based on published parameters for influenza, to describe an epidemic in a community of one million people. The model is then modified to reflect a variety of control strategies based on social distancing measures, targeted antiviral treatment and antiviral prophylaxis and home quarantine, and the effectiveness of the strategies is compared. The results suggest that the only single strategy that would be successful in preventing an epidemic (with R0=2.0) is targeted antiviral treatment and prophylaxis, and that closing schools combined with either closing work places or home quarantine would only prevent such an epidemic if these strategies were combined with a modest level of antiviral coverage. PMID:17251145

Roberts, M G; Baker, M; Jennings, L C; Sertsou, G; Wilson, N

2007-04-22

162

Adaptation of high-growth influenza H5N1 vaccine virus in Vero cells: implications for pandemic preparedness.  

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Current egg-based influenza vaccine production technology can't promptly meet the global demand during an influenza pandemic as shown in the 2009 H1N1 pandemic. Moreover, its manufacturing capacity would be vulnerable during pandemics caused by highly pathogenic avian influenza viruses. Therefore, vaccine production using mammalian cell technology is becoming attractive. Current influenza H5N1 vaccine strain (NIBRG-14), a reassortant virus between A/Vietnam/1194/2004 (H5N1) virus and egg-adapted high-growth A/PR/8/1934 virus, could grow efficiently in eggs and MDCK cells but not Vero cells which is the most popular cell line for manufacturing human vaccines. After serial passages and plaque purifications of the NIBRG-14 vaccine virus in Vero cells, one high-growth virus strain (Vero-15) was generated and can grow over 10(8) TCID(50)/ml. In conclusion, one high-growth H5N1 vaccine virus was generated in Vero cells, which can be used to manufacture influenza H5N1 vaccines and prepare reassortant vaccine viruses for other influenza A subtypes. PMID:22022351

Tseng, Yu-Fen; Hu, Alan Yung-Chih; Huang, Mei-Liang; Yeh, Wei-Zhou; Weng, Tsai-Chuan; Chen, Yu-Shuan; Chong, Pele; Lee, Min-Shi

2011-01-01

163

Adaptation of High-Growth Influenza H5N1 Vaccine Virus in Vero Cells: Implications for Pandemic Preparedness  

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Current egg-based influenza vaccine production technology can't promptly meet the global demand during an influenza pandemic as shown in the 2009 H1N1 pandemic. Moreover, its manufacturing capacity would be vulnerable during pandemics caused by highly pathogenic avian influenza viruses. Therefore, vaccine production using mammalian cell technology is becoming attractive. Current influenza H5N1 vaccine strain (NIBRG-14), a reassortant virus between A/Vietnam/1194/2004 (H5N1) virus and egg-adapted high-growth A/PR/8/1934 virus, could grow efficiently in eggs and MDCK cells but not Vero cells which is the most popular cell line for manufacturing human vaccines. After serial passages and plaque purifications of the NIBRG-14 vaccine virus in Vero cells, one high-growth virus strain (Vero-15) was generated and can grow over 108 TCID50/ml. In conclusion, one high-growth H5N1 vaccine virus was generated in Vero cells, which can be used to manufacture influenza H5N1 vaccines and prepare reassortant vaccine viruses for other influenza A subtypes. PMID:22022351

Huang, Mei-Liang; Yeh, Wei-Zhou; Weng, Tsai-Chuan; Chen, Yu-Shuan; Chong, Pele; Lee, Min-Shi

2011-01-01

164

Post-pandemic seroprevalence of pandemic influenza A (H1N1) 2009 infection (swine flu) among children <18 years in Germany.  

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Background: We determined antibodies to the pandemic influenza A (H1N1) 2009 virus in children to assess: the incidence of (H1N1) 2009 infections in the 2009/2010 season in Germany, the proportion of subclinical infections and to compare titers in vaccinated and infected children. Methodology/Principal Findings: Eight pediatric hospitals distributed over Germany prospectively provided sera from in- or outpatients aged 1 to 17 years from April 1st to July 31st 2010. Vacci...

Von Kries, Ru?diger; Weiss, Susanne; Falkenhorst, Gerhard; Wirth, Stephan; Kaiser, Petra; Huppertz, Hans-iko; Tenenbaum, Tobias; Schroten, Horst; Streng, Andrea; Liese, Johannes; Shai, Sonu; Niehues, Tim; Girschick, Hermann; Kuscher, Ellen; Sauerbrey, Axel

2011-01-01

165

Vaccine manufacture at the time of a pandemic influenza.  

Science.gov (United States)

In the event of a major influenza epidemic, the availability of a potent and safe vaccine would be a major concern. The following presentation describes the main features of a flu vaccine manufacturing campaign: beginning with the supply of embryonated eggs, in which the flu viruses are cultivated, through the different steps of vaccine production - egg harvest, purification, inactivation, splitting - down to the final vaccine formulation and aseptic filling in the appropriate containers. In usual times, such a production cycle takes over 70 weeks. In an emergency situation, the manufacturers and the authorities would have to take innovative approaches to minimize such delays. This will inevitably translate into an enormous strain on all the players in such a project, from the egg suppliers to the organisers of the vaccine dispatching and administration. It will result in suboptimal yields and costs. However, facing a massive and urgent need of vaccine, both the authorities and the vaccine manufacturers must work together to supply the necessary doses in time. PMID:7843364

Chalumeau, H P

1994-08-01

166

Skip the trip: air travelers' behavioral responses to pandemic influenza.  

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Theory suggests that human behavior has implications for disease spread. We examine the hypothesis that individuals engage in voluntary defensive behavior during an epidemic. We estimate the number of passengers missing previously purchased flights as a function of concern for swine flu or A/H1N1 influenza using 1.7 million detailed flight records, Google Trends, and the World Health Organization's FluNet data. We estimate that concern over "swine flu," as measured by Google Trends, accounted for 0.34% of missed flights during the epidemic. The Google Trends data correlates strongly with media attention, but poorly (at times negatively) with reported cases in FluNet. Passengers show no response to reported cases. Passengers skipping their purchased trips forwent at least $50 M in travel related benefits. Responding to actual cases would have cut this estimate in half. Thus, people appear to respond to an epidemic by voluntarily engaging in self-protection behavior, but this behavior may not be responsive to objective measures of risk. Clearer risk communication could substantially reduce epidemic costs. People undertaking costly risk reduction behavior, for example, forgoing nonrefundable flights, suggests they may also make less costly behavior adjustments to avoid infection. Accounting for defensive behaviors may be important for forecasting epidemics, but linking behavior with epidemics likely requires consideration of risk communication. PMID:23526970

Fenichel, Eli P; Kuminoff, Nicolai V; Chowell, Gerardo

2013-01-01

167

The national inventory of core capabilities for pandemic influenza preparedness and response: an instrument for planning and evaluation  

Science.gov (United States)

Background Reviews of the global response to the 2009 pandemic of influenza A/H1N1 affirmed the importance of assessment of preparedness and response capabilities. Design The U. S. Centers for Disease Control and Prevention (CDC) and partners developed the National Inventory of Core Capabilities for Pandemic Influenza Preparedness and Response (http://www.cdc.gov/flu/international/tools.htm) to collect data on coverage, quality, and timeliness in 12 domains: country planning, research and use of findings, communications, epidemiologic capability, laboratory capability, routine influenza surveillance, national respiratory disease surveillance and reporting, outbreak response, resources for containment, community-based interventions to prevent the spread of influenza, infection control, and health sector pandemic response. For each of the capabilities, we selected four indicators. Each indicator includes four levels of performance (0–3), ranging from no or limited capability to fully capable. Results In 2008, 40 countries in 6 regions of the World Health Organization (WHO) collected data using the instrument. In 2010 and 2012, 36 and 39 countries did so, respectively. Data collection at regular intervals allows changes in preparedness and response capabilities to be documented. In most countries, participants used the instrument and data collected to inform discussion and planning toward improving the country's level of preparedness for pandemic influenza. Conclusions The National Inventory provides countries with a systematic method to document the status of their capabilities with regard to pandemic influenza and to assess progress over time. The National Inventory produces data and findings that serve a wide range of users and uses. PMID:24373360

MacDonald, Goldie; Moen, Ann C; St Louis, Michael E

2014-01-01

168

SARS and health worker safety: lessons for influenza pandemic planning and response.  

Science.gov (United States)

The outbreak of severe acute respiratory syndrome (SARS) in 2003 provided valuable lessons for protecting health workers during an influenza pandemic or other public health crisis. In its final report, the SARS Commission concluded that a key lesson in worker safety was the precautionary principle. It stated that reasonable actions to reduce risk should not await scientific certainty. As recommended by the SARS Commission, this principle has now been enshrined in the Health Protection and Promotion Act (2007), Ontario's public health legislation and in Ontario's influenza pandemic plan. Another vital lesson for worker safety involves the occupational hygiene concept of a hierarchy of controls. It takes a holistic approach to worker safety, addressing each hazard through control at the source of the hazard, along the path between the worker and the hazard and, lastly, at the worker. Absent such an approach, the SARS Commission said worker safety may focus solely on a particular piece of personal protective equipment, such as an N95 respirator (important as it may be), or on specific policies and procedures, such as fit testing the N95 respirator to the wearer (significant as it may be). In worker safety, said the commission, the integrated whole is greater than the uncoordinated parts. The third and final worker safety lesson of SARS is the importance of having a robust safety culture in the workplace in which workers play an integral role in promoting a safe workplace. PMID:18030033

Possamai, Mario A

2007-01-01

169

Biopiracy and vaccines: Indonesia and the World Health Organization’s new Pandemic Influenza Plan  

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Full Text Available Viral samples of avian influenza are essential to preparing pre-pandemic vaccines. In 2007, the conflicting interests of the developed and developing nations led Indonesia to briefly stop sharing viral samples. The result was a struggle in which the two blocs argued for different paradigms for viral sample sharing. The first paradigm, articulated by the developed world, depicted the issue as one of health security, in which international law mandated the sharing of viral samples. The second paradigm, advanced by the developing world, depicted viral sample sharing as a form of biopiracy, which violated countries’ sovereign control of their biological resources. Ultimately, the second paradigm proved more politically effective, enabling developing nations to achieve many of their goals through the WHO’s 2011 pandemic influenza plan. This paper examines how this plan was shaped by Indonesia’s argument that the global public good required a new approach to global health governance, in order to eliminate neocolonial power relationships.

Shawn Smallman

2013-05-01

170

Preparing for an influenza pandemic: model of an immunization clinic in an urban family practice  

Science.gov (United States)

Abstract Problem addressed The surge in patient demand for the H1N1 influenza vaccine during the 2009 pandemic. Objective of the program To facilitate timely delivery of the 2009 H1N1 influenza vaccine to a family practice population while preserving regular clinic function and to create a model of effective vaccination delivery for future outbreaks. Program description An academic family practice in Toronto, Ont, adopted a process-improvement approach and implemented 3 Saturday stand-alone H1N1 vaccination clinics to accommodate increased demand for the vaccine. Medical directives were developed to give nurses the authority to vaccinate patients. Consent forms with eligibility criteria and risks versus benefits sheets were provided to patients in the waiting area to make optimal use of time. The clinic with “appointment blocks” for patients had improved efficiency (ie, fewer bottlenecks from waiting area to vaccination room), which was satisfactory to both staff and patients. Conclusion During a pandemic, when patient demand for vaccination is high, such stand-alone vaccination clinics in conjunction with family practices can deliver vaccines to patients in a timely and acceptable manner while promoting continuity of care. This model requires the commitment of extra staffing resources if regular primary care delivery is to be maintained. PMID:21998244

Bourgeois, Nicole; Franke, Carolyn; O'Connor, Shirlee A.; Shaw, Holly; Hum, Susan; Dunn, Sheila

2011-01-01

171

Genetic Characterization of Human Influenza Viruses in the Pandemic (2009-2010) and Post-Pandemic (2010-2011) Periods in Japan  

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Background Pandemic influenza A(H1N1) 2009 virus was first detected in Japan in May 2009 and continued to circulate in the 2010–2011 season. This study aims to characterize human influenza viruses circulating in Japan in the pandemic and post-pandemic periods and to determine the prevalence of antiviral-resistant viruses. Methods Respiratory specimens were collected from patients with influenza-like illness on their first visit at outpatient clinics during the 2009–2010 and 2010–2011 influenza seasons. Cycling probe real-time PCR assays were performed to screen for antiviral-resistant strains. Sequencing and phylogenetic analysis of the HA and NA genes were done to characterize circulating strains. Results and Conclusion In the pandemic period (2009–2010), the pandemic influenza A(H1N1) 2009 virus was the only circulating strain isolated. None of the 601 A(H1N1)pdm09 virus isolates had the H275Y substitution in NA (oseltamivir resistance) while 599/601 isolates (99.7%) had the S31N substitution in M2 (amantadine resistance). In the post-pandemic period (2010–2011), cocirculation of different types and subtypes of influenza viruses was observed. Of the 1,278 samples analyzed, 414 (42.6%) were A(H1N1)pdm09, 525 (54.0%) were A(H3N2) and 33 (3.4%) were type-B viruses. Among A(H1N1)pdm09 isolates, 2 (0.5%) were oseltamivir-resistant and all were amantadine-resistant. Among A(H3N2) viruses, 520 (99.0%) were amantadine-resistant. Sequence and phylogenetic analyses of A(H1N1)pdm09 viruses from the post-pandemic period showed further evolution from the pandemic period viruses. For viruses that circulated in 2010–2011, strain predominance varied among prefectures. In Hokkaido, Niigata, Gunma and Nagasaki, A(H3N2) viruses (A/Perth/16/2009-like) were predominant whereas, in Kyoto, Hyogo and Osaka, A(H1N1)pdm09 viruses (A/New_York/10/2009-like) were predominant. Influenza B Victoria(HA)-Yamagata(NA) reassortant viruses (B/Brisbane/60/2008-like) were predominant while a small proportion was in Yamagata lineage. Genetic variants with mutations at antigenic sites were identified in A(H1N1)pdm09, A(H3N2) and type-B viruses in the 2010–2011 season but did not show a change in antigenicity when compared with respective vaccine strains. PMID:22761651

Dapat, Isolde C.; Dapat, Clyde; Baranovich, Tatiana; Suzuki, Yasushi; Kondo, Hiroki; Shobugawa, Yugo; Saito, Reiko; Suzuki, Hiroshi

2012-01-01

172

Willingness to accept H1N1 pandemic influenza vaccine: A cross-sectional study of Hong Kong community nurses  

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Full Text Available Abstract Background The 2009 pandemic of influenza A (H1N1 infection has alerted many governments to make preparedness plan to control the spread of influenza A (H1N1 infection. Vaccination for influenza is one of the most important primary preventative measures to reduce the disease burden. Our study aims to assess the willingness of nurses who work for the community nursing service (CNS in Hong Kong on their acceptance of influenza A (H1N1 influenza vaccination. Methods 401 questionnaires were posted from June 24, 2009 to June 30, 2009 to community nurses with 67% response rate. Results of the 267 respondents on their willingness to accept influenza A (H1N1 vaccine were analyzed. Results Twenty-seven percent of respondents were willing to accept influenza vaccination if vaccines were available. Having been vaccinated for seasonable influenza in the previous 12 months were significantly independently associated with their willingness to accept influenza A (H1N1 vaccination (OR = 4.03; 95% CI: 2.03-7.98. Conclusions Similar to previous findings conducted in hospital healthcare workers and nurses, we confirmed that the willingness of community nurses to accept influenza A (H1N1 vaccination is low. Future studies that evaluate interventions to address nurses' specific concerns or interventions that aim to raise the awareness among nurses on the importance of influenza A (H1N1 vaccination to protect vulnerable patient populations is needed.

Wong Carmen

2010-10-01

173

Influenza Aviar y Riesgo de Pandemia / Pandemic risk of Avian Influenza  

Scientific Electronic Library Online (English)

Full Text Available SciELO Chile | Language: Spanish Abstract in spanish Influenza es una enfermedad común que se presenta en Chile en forma estacional. Ocasionalmente ocurren pandemias las que se generan cuando aparece un nuevo subtipo de virus influenza A en la humanidad producto de la recombinación de genomas de virus de influenza humano con virus de influenza de otra [...] s especies. En los últimos años la humanidad se encuentra en una situación de alerta de una nueva pandemia dada la existencia de la más grande epizootia por influenza A, subtipo H5N1 en aves que se extiende desde el Sudeste Asiático a Europa Oriental, Occidental y África. Se han documentado casos esporádicos en humanos por contacto cercano con aves infectadas. El presente artículo revisa las características virológicas del virus de influenza A, la situación actual de la epizootia por H5N1, las características de esta infección en humanos y el estado de preparación que se encuentra Chile frente a una eventual pandemia Abstract in english Influenza is a common season pathology that occasionally presents pandemia, caused by a new Influenza A virus subtype that results from the genomic recombination of human virus with virus from other species. During the last years, there is a worldwide alert situation in terms of a new pandemia, due [...] to the existence of Influenza A virus subtype H5N1 in birds from Southeast Asia, Europe and Africa. There are some sporadic cases in humans produced by close exposure with infected birds. The present article reviews the virologic characteristics of Influenza A H5N1 virus in humans and the chilean guidelines for a potential pandemia. Influenza is a respiratory disease produced by Influenza virus A,B,C, being the A type the most important due to its capacity to change structure and cause epidemia or pandemia. The last pandemias were classified as Spamsh flu in 1918-1919 (H1N1), Asian flu in 1957 (H2N2) and the Hong-Kong flu in 1967 (H3N2), with the biggest death population in 1918. In template countries, Influenza presents in epidemia affecting the winter months; in tropical countries, the virus circulation occurs during the whole year

CECILIA, PERRET P; JEANNETTE, DABANCH P.

2008-08-01

174

Influenza Aviar y Riesgo de Pandemia Pandemic risk of Avian Influenza  

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Full Text Available Influenza es una enfermedad común que se presenta en Chile en forma estacional. Ocasionalmente ocurren pandemias las que se generan cuando aparece un nuevo subtipo de virus influenza A en la humanidad producto de la recombinación de genomas de virus de influenza humano con virus de influenza de otras especies. En los últimos años la humanidad se encuentra en una situación de alerta de una nueva pandemia dada la existencia de la más grande epizootia por influenza A, subtipo H5N1 en aves que se extiende desde el Sudeste Asiático a Europa Oriental, Occidental y África. Se han documentado casos esporádicos en humanos por contacto cercano con aves infectadas. El presente artículo revisa las características virológicas del virus de influenza A, la situación actual de la epizootia por H5N1, las características de esta infección en humanos y el estado de preparación que se encuentra Chile frente a una eventual pandemiaInfluenza is a common season pathology that occasionally presents pandemia, caused by a new Influenza A virus subtype that results from the genomic recombination of human virus with virus from other species. During the last years, there is a worldwide alert situation in terms of a new pandemia, due to the existence of Influenza A virus subtype H5N1 in birds from Southeast Asia, Europe and Africa. There are some sporadic cases in humans produced by close exposure with infected birds. The present article reviews the virologic characteristics of Influenza A H5N1 virus in humans and the chilean guidelines for a potential pandemia. Influenza is a respiratory disease produced by Influenza virus A,B,C, being the A type the most important due to its capacity to change structure and cause epidemia or pandemia. The last pandemias were classified as Spamsh flu in 1918-1919 (H1N1, Asian flu in 1957 (H2N2 and the Hong-Kong flu in 1967 (H3N2, with the biggest death population in 1918. In template countries, Influenza presents in epidemia affecting the winter months; in tropical countries, the virus circulation occurs during the whole year

CECILIA PERRET P

2008-08-01

175

Influenza Aviar y Riesgo de Pandemia / Pandemic risk of Avian Influenza  

Scientific Electronic Library Online (English)

Full Text Available SciELO Chile | Language: Spanish Abstract in spanish Influenza es una enfermedad común que se presenta en Chile en forma estacional. Ocasionalmente ocurren pandemias las que se generan cuando aparece un nuevo subtipo de virus influenza A en la humanidad producto de la recombinación de genomas de virus de influenza humano con virus de influenza de otra [...] s especies. En los últimos años la humanidad se encuentra en una situación de alerta de una nueva pandemia dada la existencia de la más grande epizootia por influenza A, subtipo H5N1 en aves que se extiende desde el Sudeste Asiático a Europa Oriental, Occidental y África. Se han documentado casos esporádicos en humanos por contacto cercano con aves infectadas. El presente artículo revisa las características virológicas del virus de influenza A, la situación actual de la epizootia por H5N1, las características de esta infección en humanos y el estado de preparación que se encuentra Chile frente a una eventual pandemia Abstract in english Influenza is a common season pathology that occasionally presents pandemia, caused by a new Influenza A virus subtype that results from the genomic recombination of human virus with virus from other species. During the last years, there is a worldwide alert situation in terms of a new pandemia, due [...] to the existence of Influenza A virus subtype H5N1 in birds from Southeast Asia, Europe and Africa. There are some sporadic cases in humans produced by close exposure with infected birds. The present article reviews the virologic characteristics of Influenza A H5N1 virus in humans and the chilean guidelines for a potential pandemia. Influenza is a respiratory disease produced by Influenza virus A,B,C, being the A type the most important due to its capacity to change structure and cause epidemia or pandemia. The last pandemias were classified as Spamsh flu in 1918-1919 (H1N1), Asian flu in 1957 (H2N2) and the Hong-Kong flu in 1967 (H3N2), with the biggest death population in 1918. In template countries, Influenza presents in epidemia affecting the winter months; in tropical countries, the virus circulation occurs during the whole year

CECILIA, PERRET P; JEANNETTE, DABANCH P.

176

Computer Simulation as a Tool for Assessing Decision-Making in Pandemic Influenza Response Training  

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Full Text Available Introduction: We sought to develop and test a computer-based, interactive simulation of a hypothetical pandemic influenza outbreak. Fidelity was enhanced with integrated video and branching decision trees, built upon the 2007 federal planning assumptions. We conducted a before-and-after study of the simulation effectiveness to assess the simulations’ ability to assess participants’ beliefs regarding their own hospitals’ mass casualty incident preparedness.Methods: Development: Using a Delphi process, we finalized a simulation that serves up a minimum of over 50 key decisions to 6 role-players on networked laptops in a conference area. The simulation played out an 8-week scenario, beginning with pre-incident decisions. Testing: Role-players and trainees (N=155 were facilitated to make decisions during the pandemic. Because decision responses vary, the simulation plays out differently, and a casualty counter quantifies hypothetical losses. The facilitator reviews and critiques key factors for casualty control, including effective communications, working with external organizations, development of internal policies and procedures, maintaining supplies and services, technical infrastructure support, public relations and training. Pre- and post-survey data were compared on trainees.Results: Post-simulation trainees indicated a greater likelihood of needing to improve their organization in terms of communications, mass casualty incident planning, public information and training. Participants also recognized which key factors required immediate attention at their own home facilities.Conclusion: The use of a computer-simulation was effective in providing a facilitated environment for determining the perception of preparedness, evaluating general preparedness concepts and introduced participants to critical decisions involved in handling a regional pandemic influenza surge. [West J Emerg Med. 2013;14(3:236–242.

James M Leaming

2013-05-01

177

The Effectiveness and Mechanism of Toona sinensis Extract Inhibit Attachment of Pandemic Influenza A (H1N1) Virus.  

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TSL-1 is a fraction of the aqueous extract from the tender leaf of Toona sinensis Roem, a nutritious vegetable. The pandemic influenza A (H1N1) virus is a recently described, rapidly contagious respiratory pathogen which can cause acute respiratory distress syndrome (ARDS) and poses a major public health threat. In this study, we found that TSL-1 inhibited viral yields on MDCK plaque formation by pandemic influenza A (H1N1) virus on infected A549 cells with high selectivity index. Meanwhile, TSL-1 also suppressed viral genome loads in infected A549 cells, quantified by qRT-PCR. This study further demonstrated that TSL-1 inhibited pandemic influenza A (H1N1) virus activity through preventing attachment of A549 cells but not penetration. TSL-1 inhibited viral attachment through significant downregulation of adhesion molecules and chemokines (VCAM-1, ICAM-1, E-selectin, IL-8, and fractalkine) compared to Amantadine. Our results suggest that TSL-1 may be used as an alternative treatment and prophylaxis against pandemic influenza A (H1N1) virus. PMID:24073006

You, Huey-Ling; Chen, Chung-Jen; Eng, Hock-Liew; Liao, Pei-Lin; Huang, Sheng-Teng

2013-01-01

178

The Scourge of Asian Flu: In Utero Exposure to Pandemic Influenza and the Development of a Cohort of British Children  

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This paper examines the impact of in utero exposure to the Asian influenza pandemic of 1957 upon childhood development. Outcome data are provided by the National Child Development Study (NCDS), a panel study where all members were potentially exposed in the womb. Epidemic effects are identified using geographic variation in a surrogate measure of…

Kelly, Elaine

2011-01-01

179

A cross-sectional study of pandemic influenza health literacy and the effect of a public health campaign  

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Full Text Available Abstract Background To ascertain the understanding of 2009 pandemic (H1N1 influenza and relevant infection control measures in an emergency department population and to assess the effectiveness of education campaigns in informing the public about the pandemic. Methods Questionnaires were administered to patients, visitors, non-clinical staff and volunteers. Data were collected on knowledge, preventative measures, information sources, attitudes to government and media reporting, perceived seriousness, behaviour change and intended compliance with future measures. Results were used to construct an overall knowledge score. Results There were 252 participants. Traditional forms of mass media (138 [55%] remained the principal information source. Approximately 70% (176 accurately described mode of transmission and recommended precautions and 68% (175 reported behaviour change because of the pandemic. Gaps in knowledge included failure to identify certain high risk groups. Recall of government campaigns was significantly associated with a higher knowledge score. 60% (151 thought that authorities and media had exaggerated the threat; only 40% (101 would comply with recommended measures in a future pandemic. Conclusions The knowledge regarding pandemic influenza was high in this population and positively affected by official campaigns. Pandemic planning should address knowledge gaps and the impression that authorities had exaggerated the public-health threat.

Jhummon-Mahadnac Namrata

2012-07-01

180

Social contact networks for the spread of pandemic influenza in children and teenagers  

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Full Text Available Abstract Background Influenza is a viral infection that primarily spreads via fluid droplets from an infected person's coughs and sneezes to others nearby. Social contact networks and the way people interact within them are thus important to its spread. We developed a method to characterize the social contact network for the potential transmission of influenza and then applied the method to school aged children and teenagers. Methods Surveys were administered to students in an elementary, middle and high-school in the United States. The social contact network of a person was conceptualized as a set of groups to which they belong (e.g., households, classes, clubs each composed of a sub-network of primary links representing the individuals within each group that they contact. The size of the group, number of primary links, time spent in the group, and level of contact along each primary link (near, talking, touching, or kissing were characterized. Public activities done by groups venturing into the community where random contacts occur (e.g., friends viewing a movie also were characterized. Results Students, groups and public activities were highly heterogeneous. Groups with high potential for the transmission of influenza were households, school classes, friends, and sports; households decreased and friends and sports increased in importance with grade level. Individual public activity events (such as dances were also important but lost their importance when averaged over time. Random contacts, primarily in school passing periods, were numerous but had much lower transmission potential compared to those with primary links within groups. Students are highly assortative, interacting mainly within age class. A small number of individual students are identified as likely "super-spreaders". Conclusion High-school students may form the local transmission backbone of the next pandemic. Closing schools and keeping students at home during a pandemic would remove the transmission potential within these ages and could be effective at thwarting its spread within a community. Social contact networks characterized as groups and public activities with the time, level of contact and primary links within each, yields a comprehensive view, which if extended to all ages, would allow design of effective community containment for pandemic influenza.

Glass Robert J

2008-02-01

 
 
 
 
181

A 'small-world-like' model for comparing interventions aimed at preventing and controlling influenza pandemics  

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Full Text Available Abstract Background With an influenza pandemic seemingly imminent, we constructed a model simulating the spread of influenza within the community, in order to test the impact of various interventions. Methods The model includes an individual level, in which the risk of influenza virus infection and the dynamics of viral shedding are simulated according to age, treatment, and vaccination status; and a community level, in which meetings between individuals are simulated on randomly generated graphs. We used data on real pandemics to calibrate some parameters of the model. The reference scenario assumes no vaccination, no use of antiviral drugs, and no preexisting herd immunity. We explored the impact of interventions such as vaccination, treatment/prophylaxis with neuraminidase inhibitors, quarantine, and closure of schools or workplaces. Results In the reference scenario, 57% of realizations lead to an explosive outbreak, lasting a mean of 82 days (standard deviation (SD 12 days and affecting 46.8% of the population on average. Interventions aimed at reducing the number of meetings, combined with measures reducing individual transmissibility, would be partly effective: coverage of 70% of affected households, with treatment of the index patient, prophylaxis of household contacts, and confinement to home of all household members, would reduce the probability of an outbreak by 52%, and the remaining outbreaks would be limited to 17% of the population (range 0.8%–25%. Reactive vaccination of 70% of the susceptible population would significantly reduce the frequency, size, and mean duration of outbreaks, but the benefit would depend markedly on the interval between identification of the first case and the beginning of mass vaccination. The epidemic would affect 4% of the population if vaccination started immediately, 17% if there was a 14-day delay, and 36% if there was a 28-day delay. Closing schools when the number of infections in the community exceeded 50 would be very effective, limiting the size of outbreaks to 10% of the population (range 0.9%–22%. Conclusion This flexible tool can help to determine the interventions most likely to contain an influenza pandemic. These results support the stockpiling of antiviral drugs and accelerated vaccine development.

Sallé Anne-Violaine

2006-10-01

182

[In vivo efficacy of Ingavirin against pandemic A (H1N1/09)v influenza virus].  

Science.gov (United States)

Ingavirin was shown to be efficient in inhibition of the pandemic influenza virus strains A/California/04/2009 (H1N1)v, A/California/07/2009 (H1N1)v, A/Moscow/225/2009 (H1N1)v and A/Moscow/226/2009 (H1N1)v. as well as the influenza virus strain A/Aichi/2/68 (H3N2) in the lungs of the infected mice. After oral administration of Ingavirin the titers of the influenza virus strains in the lung homogenates lowered. PMID:21033472

Shishkina, L N; Nebol'sin, V E; Skarnovich, M O; Kabanov, A S; Sergeev, A A; Erdyneeva, U B; Serova, O A; Demina, O K; Agafonov, A P; Stavski?, E A; Drozdov, I G

2010-01-01

183

Targets for the Induction of Protective Immunity Against Influenza A Viruses  

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Full Text Available The current pandemic caused by the new influenza A(H1N1 virus of swine origin and the current pandemic threat caused by the highly pathogenic avian influenza A viruses of the H5N1 subtype have renewed the interest in the development of vaccines that can induce broad protective immunity. Preferably, vaccines not only provide protection against the homologous strains, but also against heterologous strains, even of another subtype. Here we describe viral targets and the arms of the immune response involved in protection against influenza virus infections such as antibodies directed against the hemagglutinin, neuraminidase and the M2 protein and cellular immune responses directed against the internal viral proteins.

Guus F. Rimmelzwaan

2010-01-01

184

Influenza A(H1N1)pdm09 in England, 2009 to 2011: a greater burden of severe illness in the year after the pandemic than in the pandemic year.  

Science.gov (United States)

Influenza pandemics are often perceived as single-year events, but the burden of previous influenza pandemics has in reality been spread over a number of years. The aim of this paper is to compare the burden of influenza in the pandemic year 2009/10 with that in the year immediately after (2010/11) in England. We compared four measures of disease. There was a greater burden of severe illness in 2010/11 compared with 2009/10: more deaths (474 vs 361), more critical care admissions (2,200 vs 1,700), and more hospital admissions (8,797 vs 7,879). In contrast, there were fewer general practice consultations in 2010/11 compared with 2009/10 (370,000 vs 580,000). There was also much less public interest in influenza, as assessed by number of Google searches. This is a worrying finding, as by the time of the second influenza season, much had been learnt about the potential impact of the influenza A(H1N1)pdm09 virus and an effective vaccine developed. We suggest that a widespread assumption of 'mildness' led to insufficient ongoing action to prevent influenza and hence to avoidable influenza-related deaths. This offers a lesson to all countries, both for future influenza seasons and for pandemic preparedness planning. PMID:22516004

Mytton, O T; Rutter, P D; Donaldson, L J

2012-01-01

185

Superior In Vitro Stimulation of Human CD8+ T-Cells by Whole Virus versus Split Virus Influenza Vaccines  

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Pandemic and seasonal influenza viruses cause considerable morbidity and mortality in the general human population. Protection from severe disease may result from vaccines that activate antigen-presenting DC for effective stimulation of influenza-specific memory T cells. Special attention is paid to vaccine-induced CD8+ T-cell responses, because they are mainly directed against conserved internal influenza proteins thereby presumably mediating cross-protection against circulating seasonal as well as emerging pandemic virus strains. Our study showed that influenza whole virus vaccines of major seasonal A and B strains activated DC more efficiently than those of pandemic swine-origin H1N1 and pandemic-like avian H5N1 strains. In contrast, influenza split virus vaccines had a low ability to activate DC, regardless which strain was investigated. We also observed that whole virus vaccines stimulated virus-specific CD8+ memory T cells much stronger compared to split virus counterparts, whereas both vaccine formats activated CD4+ Th cell responses similarly. Moreover, our data showed that whole virus vaccine material is delivered into the cytosolic pathway of DC for effective activation of virus-specific CD8+ T cells. We conclude that vaccines against seasonal and pandemic (-like) influenza strains that aim to stimulate cross-reacting CD8+ T cells should include whole virus rather than split virus formulations. PMID:25072749

Distler, Eva; Dass, Martin; Wagner, Eva M.; Plachter, Bodo; Probst, Hans Christian; Strand, Dennis; Hartwig, Udo F.; Karner, Anita; Aichinger, Gerald; Kistner, Otfried; Landfester, Katharina; Herr, Wolfgang

2014-01-01

186

Epidemiology of fatal cases associated with pandemic influenza reported in Yemen  

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Full Text Available Objectives: This study describes the incidence of all fatal cases associated with Pandemic Influenza A (H1N1 in Yemen. It sets out to highlight the factors associated with poor prognosis *The authors declare that they have no competing interests. to enhance the implementation of prevention and control programs. Methods: The study is based on retrospective analysis of available data until 14 March 2010, as compiled by the disease control and surveillance team in Yemen. Results: Between 16 June 2009 and 14 March 2010, a total of 33 laboratory-confirmed death cases associated with pandemic influenza A (H1N1 were reported to the Diseases Control and Surveillance in the Ministry of Public Health and Population. During this period, a total of 6049 suspected influenza A (H1N1 cases were recorded. With this denominator, the case fatality rate (CFR was 0.54%. During June through August, H1N1 confirmed cases were infrequently detected, including only 30; however, from September through December, over 200 confirmed cases were reported each month. Of the 33 cases recorded, 25 were male (76% and 8 were female (24%, male to female ratio being 3:1. Overall median age of the death cases was 30.8 years (range 1 - 55. The most common diagnosis upon admission was pneumonia. Out of the deaths, twenty five (75.8% had no documented underlying diseases. Chronic cardiovascular disease (9.1% was the most commonly reported disease and 2 deaths (6.1% were recorded as pregnant women. Conclusions: The most common diagnosis upon admission was pneumonia. Chronic cardiovascular diseases were the most commonly reported underlying conditions, while the most identified risk factor was pregnancy. These findings should be taken into consideration, when vaccination strategies are employed.

Ahmed A. K. Thabet

2012-11-01

187

Detection of highly pathogenic influenza and pandemic influenza virus in formalin fixed tissues by immunohistochemical methods.  

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Tissues infected with highly pathogenic avian influenza viruses such as H5N1 and H7N7 are normally required to be fixed in formalin or paraformaldehyde before examination in order to inactivate the virus. In this study commercially available monoclonal antibodies to the influenza nucleoprotein (NP) were evaluated in order to determine which antibodies would identify positive cells in tissues fixed in formalin or paraformaldehyde. An assessment of which antigen retrieval process would unmask antigens blocked by formalin fixation was also made. Of six commercially available monoclonal antibodies tested, only one (HB65, European Veterinary Laboratories) was able to identify all formalin fixed avian, swine and human influenza virus infected tissues, and this was after pronase induced epitope retrieval. This monoclonal antibody is recommended for routine diagnostic use for the detection of influenza A infected tissues that have been fixed in formalin or paraformaldehyde. PMID:22108429

Nicholls, John M; Wong, Linda P W; Chan, Renee W Y; Poon, Leo L M; So, Leo K Y; Yen, Hui-Ling; Fung, Kevin; van Poucke, Sjouke; Peiris, J S Malik

2012-02-01

188

Fully human broadly neutralizing monoclonal antibodies against influenza A viruses generated from the memory B cells of a 2009 pandemic H1N1 influenza vaccine recipient  

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Whether the 2009 pandemic H1N1 influenza vaccine can induce heterosubtypic cross-protective anti-hemagglutinin (HA) neutralizing antibodies is an important issue. We obtained a panel of fully human monoclonal antibodies from the memory B cells of a 2009 pandemic H1N1 influenza vaccine recipient. Most of the monoclonal antibodies targeted the HA protein but not the HA1 fragment. Among the analyzed antibodies, seven mAbs exhibited neutralizing activity against several influenza A viruses of different subtypes. The conserved linear epitope targeted by the neutralizing mAbs (FIEGGWTGMVDGWYGYHH) is part of the fusion peptide on HA2. Our work suggests that a heterosubtypic neutralizing antibody response primarily targeting the HA stem region exists in recipients of the 2009 pandemic H1N1 influenza vaccine. The HA stem region contains various conserved neutralizing epitopes with the fusion peptide as an important one. This work may aid in the design of a universal influenza A virus vaccine.

Hu, Weibin [Molecular Virus Unit, Key Laboratory of Molecular Virology and Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai 200025 (China); Chen, Aizhong [Key Laboratory of Molecular Cell Biology, Institute of Biochemistry and Cell Biology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031 (China); Miao, Yi [Shanghai Xuhui Central Hospital, Shanghai 200031 (China); Xia, Shengli [Center for Disease Control and Prevention of Henan Province, Zhengzhou 450016 (China); Ling, Zhiyang; Xu, Ke; Wang, Tongyan [Molecular Virus Unit, Key Laboratory of Molecular Virology and Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai 200025 (China); Xu, Ying; Cui, Jun; Wu, Hongqiang; Hu, Guiyu; Tian, Lin; Wang, Lingling [Key Laboratory of Molecular Cell Biology, Institute of Biochemistry and Cell Biology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031 (China); Shu, Yuelong [Chinese Center for Disease Control and Prevention, Beijing 102206 (China); Ma, Xiaowei [Hualan Biological Bacterin Company, Xinxiang 453003 (China); Xu, Bianli; Zhang, Jin [Center for Disease Control and Prevention of Henan Province, Zhengzhou 450016 (China); Lin, Xiaojun, E-mail: linxiaojun@hualan.com [Hualan Biological Bacterin Company, Xinxiang 453003 (China); Bian, Chao, E-mail: cbian@sibs.ac.cn [Key Laboratory of Molecular Cell Biology, Institute of Biochemistry and Cell Biology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031 (China); Sun, Bing, E-mail: bsun@sibs.ac.cn [Molecular Virus Unit, Key Laboratory of Molecular Virology and Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai 200025 (China); Key Laboratory of Molecular Cell Biology, Institute of Biochemistry and Cell Biology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031 (China)

2013-01-20

189

Fully human broadly neutralizing monoclonal antibodies against influenza A viruses generated from the memory B cells of a 2009 pandemic H1N1 influenza vaccine recipient  

International Nuclear Information System (INIS)

Whether the 2009 pandemic H1N1 influenza vaccine can induce heterosubtypic cross-protective anti-hemagglutinin (HA) neutralizing antibodies is an important issue. We obtained a panel of fully human monoclonal antibodies from the memory B cells of a 2009 pandemic H1N1 influenza vaccine recipient. Most of the monoclonal antibodies targeted the HA protein but not the HA1 fragment. Among the analyzed antibodies, seven mAbs exhibited neutralizing activity against several influenza A viruses of different subtypes. The conserved linear epitope targeted by the neutralizing mAbs (FIEGGWTGMVDGWYGYHH) is part of the fusion peptide on HA2. Our work suggests that a heterosubtypic neutralizing antibody response primarily targeting the HA stem region exists in recipients of the 2009 pandemic H1N1 influenza vaccine. The HA stem region contains various conserved neutralizing epitopes with the fusion peptide as an important one. This work may aid in the design of a universal influenza A virus vaccine.

190

[Protective activity of Ingavirin in experimental lethal influenza due to pandemic influenza virus A (H1N1)v in albino mice].  

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Despite obvious success in the vaccine development and chemotherapy of influenza, it remains a poorly controlled infection leading to emergence of new pandemic variants of the virus with high morbidity and mortality. We investigated the protective activity of Ingavirin against the lethal influenza A (H1N1) 2009 virus infection on albino mice. Oral use of Ingavirin resulted in sharp decreasing of the mortality (index of protection up to 57%), slight decreasing of the infectious titer of the virus in the lungs (up to 40-fold), normalizing of the body weight dynamics and the lung tissue structure vs. the placebo-treated control. The degree of the bronchial epithelium damage was also strongly decreased. The results allow to consider Ingavirin as an effective antiviral against the current pandemic influenza virus. PMID:21033471

Zarubaev, V V; Garshinina, A V; Kalinina, N A; Shtro, A A; Beliaevskaia, S V; Nebol'sin, V E; Kiselev, O I

2010-01-01

191

Factors associated with 2009 pandemic influenza A (H1N1 vaccination acceptance among university students from India during the post-pandemic phase  

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Full Text Available Abstract Background There was a low adherence to influenza A (H1N1 vaccination program among university students and health care workers during the pandemic influenza in many parts of the world. Vaccination of high risk individuals is one of the recommendations of World Health Organization during the post-pandemic period. It is not documented about the student's knowledge, attitude and willingness to accept H1N1 vaccination during the post-pandemic period. We aimed to analyze the student's knowledge, attitude and willingness to accept H1N1 vaccination during the post-pandemic period in India. Methods Vaccine against H1N1 was made available to the students of Vellore Institute of Technology, India from September 2010. The data are based on a cross-sectional study conducted during October 2010 to January 2011 using a self-administered questionnaire with a representative sample of the student population (N = 802. Results Of the 802 respondents, only 102/802 (12.7% had been vaccinated and 105/802 (13% planned to do so in the future, while 595/802 (74% would probably or definitely not get vaccinated in the future. The highest coverage was among the female (65/102, 63.7% and non-compliance was higher among men in the group (384/595; 64.5% (p Conclusions Our study shows that the vaccination coverage among university students remains very low in the post-pandemic period and doubts about the safety and effectiveness of the vaccine are key elements in their rejection. Our results indicate a need to provide accessible information about the vaccine safety by scientific authorities and fill gaps and confusions in this regard.

Thejaswini Venkatesh

2011-07-01

192

Pandemic influenza preparedness and health systems challenges in Asia: results from rapid analyses in 6 Asian countries  

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Full Text Available Abstract Background Since 2003, Asia-Pacific, particularly Southeast Asia, has received substantial attention because of the anticipation that it could be the epicentre of the next pandemic. There has been active investment but earlier review of pandemic preparedness plans in the region reveals that the translation of these strategic plans into operational plans is still lacking in some countries particularly those with low resources. The objective of this study is to understand the pandemic preparedness programmes, the health systems context, and challenges and constraints specific to the six Asian countries namely Cambodia, Indonesia, Lao PDR, Taiwan, Thailand, and Viet Nam in the prepandemic phase before the start of H1N1/2009. Methods The study relied on the Systemic Rapid Assessment (SYSRA toolkit, which evaluates priority disease programmes by taking into account the programmes, the general health system, and the wider socio-cultural and political context. The components under review were: external context; stewardship and organisational arrangements; financing, resource generation and allocation; healthcare provision; and information systems. Qualitative and quantitative data were collected in the second half of 2008 based on a review of published data and interviews with key informants, exploring past and current patterns of health programme and pandemic response. Results The study shows that health systems in the six countries varied in regard to the epidemiological context, health care financing, and health service provision patterns. For pandemic preparation, all six countries have developed national governance on pandemic preparedness as well as national pandemic influenza preparedness plans and Avian and Human Influenza (AHI response plans. However, the governance arrangements and the nature of the plans differed. In the five developing countries, the focus was on surveillance and rapid containment of poultry related transmission while preparation for later pandemic stages was limited. The interfaces and linkages between health system contexts and pandemic preparedness programmes in these countries were explored. Conclusion Health system context influences how the six countries have been preparing themselves for a pandemic. At the same time, investment in pandemic preparation in the six Asian countries has contributed to improvement in health system surveillance, laboratory capacity, monitoring and evaluation and public communications. A number of suggestions for improvement were presented to strengthen the pandemic preparation and mitigation as well as to overcome some of the underlying health system constraints.

Putthasri Weerasak

2010-06-01

193

GLA-AF, an Emulsion-Free Vaccine Adjuvant for Pandemic Influenza  

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The ongoing threat from Influenza necessitates the development of new vaccine and adjuvant technologies that can maximize vaccine immunogenicity, shorten production cycles, and increase global vaccine supply. Currently, the most successful adjuvants for Influenza vaccines are squalene-based oil-in-water emulsions. These adjuvants enhance seroprotective antibody titers to homologous and heterologous strains of virus, and augment a significant dose sparing activity that could improve vaccine manufacturing capacity. As an alternative to an emulsion, we tested a simple lipid-based aqueous formulation containing a synthetic TLR4 ligand (GLA-AF) for its ability to enhance protection against H5N1 infection. GLA-AF was very effective in adjuvanting recombinant H5 hemagglutinin antigen (rH5) in mice and was as potent as the stable emulsion, SE. Both adjuvants induced similar antibody titers using a sub-microgram dose of rH5, and both conferred complete protection against a highly pathogenic H5N1 challenge. However, GLA-AF was the superior adjuvant in ferrets. GLA-AF stimulated a broader antibody response than SE after both the prime and boost immunization with rH5, and ferrets were better protected against homologous and heterologous strains of H5N1 virus. Thus, GLA-AF is a potent emulsion-free adjuvant that warrants consideration for pandemic influenza vaccine development. PMID:24551202

Clegg, Christopher H.; Roque, Richard; Perrone, Lucy A.; Rininger, Joseph A.; Bowen, Richard; Reed, Steven G.

2014-01-01

194

Preliminary study about sublingual administration of bacteria-expressed pandemic H1N1 influenza vaccine in miniature pigs.  

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Sublingual (SL) administration of influenza vaccine would be non-invasive and effective way to give human populations protective immunity against the virus, especially when pandemic influenza outbreaks. In this study, the efficacy of pandemic influenza virus-based subunit vaccines was tested after sublingual (SL) adjuvant administration in pigs. Eight specific pathogen-free Yucatan pigs were divided into 4 groups: nonvaccinated but challenged (A) and vaccinated and challenged (B, C, and D). The vaccinated groups were subdivided by vaccine type and inoculation route: SL subunit vaccine (hemagglutinin antigen 1 [HA1] + wild-type cholera toxin [wtCT], B); IM subunit vaccine (HA1 + aluminum hydroxide, C); and IM inactivated vaccine (+ aluminum hydroxide, D). The vaccines were administered twice at a 2-week interval. All pigs were challenged with pandemic influenza virus (A/swine/GCVP-KS01/2009 [H1N1]) and monitored for clinical signs, serology, viral shedding, and histopathology. After vaccination, hemagglutination inhibition titre was higher in group D (320) than in the other vaccinated groups (40-80) at the time of challenge. The mobility and feed intake were reduced in group C. Both viral shedding and histopathological lesions were reduced in groups B and D. Although this study has limitation due to the limited number of pigs (2 pigs per a group), the preliminary data in this study provided the protective potential of SL administration of bacteria-expressed pandemic H1N1 influenza vaccine in pigs. There should be additional animal studies about effective adjuvant system and vaccine types for the use of SL influenza vaccination. PMID:25079956

Kim, Hyekwon; Kim, Jeong-Ki; Song, Hohyun; Choi, Jungah; Shim, Byoungshik; Kang, Bokyu; Moon, Hyoungjoon; Yeom, Minjoo; Kim, Sang-Hyun; Song, Daesub; Song, Manki

2014-09-01

195

An H5N1 M2e-based multiple antigenic peptide vaccine confers heterosubtypic protection from lethal infection with pandemic 2009 H1N1 virus  

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Full Text Available Abstract Background A 2009 global influenza pandemic caused by a novel swine-origin H1N1 influenza A virus has posted an increasing threat of a potential pandemic by the highly pathogenic avian influenza (HPAI H5N1 virus, driving us to develop an influenza vaccine which confers cross-protection against both H5N1 and H1N1 viruses. Previously, we have shown that a tetra-branched multiple antigenic peptide (MAP vaccine based on the extracellular domain of M2 protein (M2e from H5N1 virus (H5N1-M2e-MAP induced strong immune responses and cross-protection against different clades of HPAI H5N1 viruses. In this report, we investigated whether such M2e-MAP presenting the H5N1-M2e consensus sequence can afford heterosubtypic protection from lethal challenge with the pandemic 2009 H1N1 virus. Results Our results demonstrated that H5N1-M2e-MAP plus Freund's or aluminum adjuvant induced strong cross-reactive IgG antibody responses against M2e of the pandemic H1N1 virus which contains one amino acid variation with M2e of H5N1 at position 13. These cross-reactive antibodies may maintain for 6 months and bounced back quickly to the previous high level after the 2nd boost administered 2 weeks before virus challenge. H5N1-M2e-MAP could afford heterosubtypic protection against lethal challenge with pandemic H1N1 virus, showing significant decrease of viral replications and obvious alleviation of histopathological damages in the challenged mouse lungs. 100% and 80% of the H5N1-M2e-MAP-vaccinated mice with Freund's and aluminum adjuvant, respectively, survived the lethal challenge with pandemic H1N1 virus. Conclusions Our results suggest that H5N1-M2e-MAP has a great potential to prevent the threat from re-emergence of pandemic H1N1 influenza and possible novel influenza pandemic due to the reassortment of HPAI H5N1 virus with the 2009 swine-origin H1N1 influenza virus.

Yu Hong

2010-07-01

196

The feasibility of age-specific travel restrictions during influenza pandemics  

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Full Text Available Abstract Background Epidemiological studies have shown that imposing travel restrictions to prevent or delay an influenza pandemic may not be feasible. To delay an epidemic substantially, an extremely high proportion of trips (~99% would have to be restricted in a homogeneously mixing population. Influenza is, however, strongly influenced by age-dependent transmission dynamics, and the effectiveness of age-specific travel restrictions, such as the selective restriction of travel by children, has yet to be examined. Methods A simple stochastic model was developed to describe the importation of infectious cases into a population and to model local chains of transmission seeded by imported cases. The probability of a local epidemic, and the time period until a major epidemic takes off, were used as outcome measures, and travel restriction policies in which children or adults were preferentially restricted were compared to age-blind restriction policies using an age-dependent next generation matrix parameterized for influenza H1N1-2009. Results Restricting children from travelling would yield greater reductions to the short-term risk of the epidemic being established locally than other policy options considered, and potentially could delay an epidemic for a few weeks. However, given a scenario with a total of 500 imported cases over a period of a few months, a substantial reduction in the probability of an epidemic in this time period is possible only if the transmission potential were low and assortativity (i.e. the proportion of contacts within-group were unrealistically high. In all other scenarios considered, age-structured travel restrictions would not prevent an epidemic and would not delay the epidemic for longer than a few weeks. Conclusions Selectively restricting children from traveling overseas during a pandemic may potentially delay its arrival for a few weeks, depending on the characteristics of the pandemic strain, but could have less of an impact on the economy compared to restricting adult travelers. However, as long as adults have at least a moderate potential to trigger an epidemic, selectively restricting the higher risk group (children may not be a practical option to delay the arrival of an epidemic substantially.

Lam Elson HY

2011-11-01

197

Impact of antiviral treatment and hospital admission delay on risk of death associated with 2009 A/H1N1 pandemic influenza in Mexico  

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Full Text Available Abstract Background Increasing our understanding of the factors affecting the severity of the 2009 A/H1N1 influenza pandemic in different regions of the world could lead to improved clinical practice and mitigation strategies for future influenza pandemics. Even though a number of studies have shed light into the risk factors associated with severe outcomes of 2009 A/H1N1 influenza infections in different populations (e.g., [1-5], analyses of the determinants of mortality risk spanning multiple pandemic waves and geographic regions are scarce. Between-country differences in the mortality burden of the 2009 pandemic could be linked to differences in influenza case management, underlying population health, or intrinsic differences in disease transmission [6]. Additional studies elucidating the determinants of disease severity globally are warranted to guide prevention efforts in future influenza pandemics. In Mexico, the 2009 A/H1N1 influenza pandemic was characterized by a three-wave pattern occurring in the spring, summer, and fall of 2009 with substantial geographical heterogeneity [7]. A recent study suggests that Mexico experienced high excess mortality burden during the 2009 A/H1N1 influenza pandemic relative to other countries [6]. However, an assessment of potential factors that contributed to the relatively high pandemic death toll in Mexico are lacking. Here, we fill this gap by analyzing a large series of laboratory-confirmed A/H1N1 influenza cases, hospitalizations, and deaths monitored by the Mexican Social Security medical system during April 1 through December 31, 2009 in Mexico. In particular, we quantify the association between disease severity, hospital admission delays, and neuraminidase inhibitor use by demographic characteristics, pandemic wave, and geographic regions of Mexico. Methods We analyzed a large series of laboratory-confirmed pandemic A/H1N1 influenza cases from a prospective surveillance system maintained by the Mexican Social Security system, April-December 2009. We considered a spectrum of disease severity encompassing outpatient visits, hospitalizations, and deaths, and recorded demographic and geographic information on individual patients. We assessed the impact of neuraminidase inhibitor treatment and hospital admission delay (? > 2 days after disease onset on the risk of death by multivariate logistic regression. Results Approximately 50% of all A/H1N1-positive patients received antiviral medication during the Spring and Summer 2009 pandemic waves in Mexico while only 9% of A/H1N1 cases received antiviral medications during the fall wave (P? Conclusions Our findings underscore the potential impact of decreasing admission delays and increasing antiviral use to mitigate the mortality burden of future influenza pandemics.

Chowell Gerardo

2012-04-01

198

Large-scale Individual-based Models of Pandemic Influenza Mitigation Strategies  

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We have developed a large-scale stochastic simulation model to investigate the spread of a pandemic strain of influenza virus through the U.S. population of 281 million people, to assess the likely effectiveness of various potential intervention strategies including antiviral agents, vaccines, and modified social mobility (including school closure and travel restrictions) [1]. The heterogeneous population structure and mobility is based on available Census and Department of Transportation data where available. Our simulations demonstrate that, in a highly mobile population, restricting travel after an outbreak is detected is likely to delay slightly the time course of the outbreak without impacting the eventual number ill. For large basic reproductive numbers R0, we predict that multiple strategies in combination (involving both social and medical interventions) will be required to achieve a substantial reduction in illness rates. [1] T. C. Germann, K. Kadau, I. M. Longini, and C. A. Macken, Proc. Natl. Acad. Sci. (USA) 103, 5935-5940 (2006).

Kadau, Kai; Germann, Timothy; Longini, Ira; Macken, Catherine

2007-03-01

199

Genealogy with seasonality, the basic reproduction number, and the influenza pandemic.  

Science.gov (United States)

The basic reproduction number R (0) has been used in population biology, especially in epidemiology, for several decades. But a suitable definition in the case of models with periodic coefficients was given only in recent years. The definition involves the spectral radius of an integral operator. As in the study of structured epidemic models in a constant environment, there is a need to emphasize the biological meaning of this spectral radius. In this paper we show that R (0) for periodic models is still an asymptotic per generation growth rate. We also emphasize the difference between this theoretical R (0) for periodic models and the "reproduction number" obtained by fitting an exponential to the beginning of an epidemic curve. This difference has been overlooked in recent studies of the H1N1 influenza pandemic. PMID:20607242

Bacaër, Nicolas; Ait Dads, El Hadi

2011-05-01

200

New pandemics: HIV and AIDS, HCV and chronic hepatitis, Influenza virus and flu  

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Full Text Available Abstract New pandemics are a serious threat to the health of the entire world. They are essentially of viral origin and spread at large speed. A meeting on this topic was held in Lyon, France, within the XIXth Jacques Cartier Symposia, a series of France-Québec meetings held every year. New findings on HIV and AIDS, on HCV and chronic hepatitis, and an update on influenza virus and flu were covered during this meeting on December 4 and 5, 2006. Aspects of viral structure, virus-host interactions, antiviral defenses, drugs and vaccinations, and epidemiological aspects were discussed for HIV and HCV. Old and recent data on the flu epidemics ended this meeting.

Cohen Éric A

2007-02-01

 
 
 
 
201

An analysis of national target groups for monovalent 2009 pandemic influenza vaccine and trivalent seasonal influenza vaccines in 2009-10 and 2010-11  

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Full Text Available Abstract Background Vaccination is generally considered to be the best primary prevention measure against influenza virus infection. Many countries encourage specific target groups of people to undertake vaccination, often with financial subsidies or a priority list. To understand differential patterns of national target groups for influenza vaccination before, during and after the 2009 influenza pandemic, we reviewed and analyzed the country-specific policies in the corresponding time periods. Methods Information on prioritized groups targeted to receive seasonal and pandemic influenza vaccines was derived from a multi-step internet search of official health department websites, press releases, media sources and academic journal articles. We assessed the frequency and consistency of targeting 20 different groups within populations which are associated with age, underlying medical conditions, role or occupations among different countries and vaccines. Information on subsidies provided to specific target groups was also extracted. Results We analyzed target groups for 33 (seasonal 2009 and 2009-10 vaccines, 72 (monovalent pandemic 2009-10 vaccine and 34 (seasonal 2010 and 2010-11 vaccines countries. In 2009-10, the elderly, those with chronic illness and health care workers were common targets for the seasonal vaccine. Comparatively, the elderly, care home residents and workers, animal contacts and close contacts were less frequently targeted to receive the pandemic vaccine. Pregnant women, obese persons, essential community workers and health care workers, however, were more commonly targeted. After the pandemic, pregnant women, obese persons, health care and care home workers, and close contacts were more commonly targeted to receive the seasonal vaccine compared to 2009-10, showing continued influence from the pandemic. Many of the countries provided free vaccines, partial subsidies, reimbursements or national health insurance coverage to specific target groups and over one-third of the countries offered universal subsidy regarding the pandemic vaccine. There was also some inconsistency between countries in target groups. Conclusions Differences in target groups between countries may reflect variable objectives as well as uncertainties regarding the transmission dynamics, severity and age-specific immunity against influenza viruses before and after vaccination. Clarification on these points is essential to elucidate optimal and object-oriented vaccination strategies.

Lee Esther ST

2011-08-01

202

A duplex real-time RT-PCR assay for detecting H5N1 avian influenza virus and pandemic H1N1 influenza virus  

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Full Text Available Abstract A duplex real-time reverse transcriptase polymerase chain reaction (RT-PCR assay was improved for simultaneous detection of highly pathogenic H5N1 avian influenza virus and pandemic H1N1 (2009 influenza virus, which is suitable for early diagnosis of influenza-like patients and for epidemiological surveillance. The sensitivity of this duplex real-time RT-PCR assay was 0.02 TCID50 (50% tissue culture infective dose for H5N1 and 0.2 TCID50 for the pandemic H1N1, which was the same as that of each single-target RT-PCR for pandemic H1N1 and even more sensitive for H5N1 with the same primers and probes. No cross reactivity of detecting other subtype influenza viruses or respiratory tract viruses was observed. Two hundred and thirty-six clinical specimens were tested by comparing with single real-time RT-PCR and result from the duplex assay was 100% consistent with the results of single real-time RT-PCR and sequence analysis.

Qin E-de

2010-06-01

203

Human H-ficolin inhibits replication of seasonal and pandemic influenza A viruses  

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The collectins have been shown to have a role in host defense against influenza A virus (IAV) and other significant viral pathogens (e.g., HIV). The ficolins are a related group of innate immune proteins that are present at relatively high concentrations in serum, but also in respiratory secretions; however, there has been little study of the role of ficolins in viral infection. In this study, we demonstrate that purified recombinant human H-ficolin and H-ficolin in human serum and bronchoalveolar lavage fluid bind to IAV and inhibit viral infectivity and hemagglutination activity in vitro. Removal of ficolins from human serum or bronchoalveolar lavage fluid reduces their antiviral activity. Inhibition of IAV did not involve the calcium-dependent lectin activity of H-ficolin. We demonstrate that H-ficolin is sialylated and that removal of sialic acid abrogates IAV inhibition, while addition of the neuraminidase inhibitor oseltamivir potentiates neutralization, hemagglutinin inhibition, and viral aggregation caused by H-ficolin. Pandemic and mouse-adapted strains of IAV are generally not inhibited by the collectins surfactant protein D or mannose binding lectin because of a paucity of glycan attachments on the hemagglutinin of these strains. In contrast, H-ficolin inhibited both the mouse-adapted PR-8 H1N1 strain and a pandemic H1N1 strain from 2009. H-ficolin also fixed complement to a surface coated with IAV. These findings suggest that H-ficolin contributes to host defense against IAV.

Verma, Anamika; White, Mitchell

2012-01-01

204

How integration of global omics-data could help preparing for pandemics - a scent of influenza.  

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Pandemics caused by novel emerging or re-emerging infectious diseases could lead to high mortality and morbidity world-wide when left uncontrolled. In this perspective, we evaluate the possibility of integration of global omics-data in order to timely prepare for pandemics. Such an approach requires two major innovations. First, data that is obtained should be shared with the global community instantly. The strength of rapid integration of simple signals is exemplified by Google's(TM) Flu Trend, which could predict the incidence of influenza-like illness based on online search engine queries. Second, omics technologies need to be fast and high-throughput. We postulate that analysis of the exhaled breath would be a simple, rapid and non-invasive alternative. Breath contains hundreds of volatile organic compounds that are altered by infection and inflammation. The molecular fingerprint of breath (breathprint) can be obtained using an electronic nose, which relies on sensor technology. These breathprints can be stored in an online database (a "breathcloud") and coupled to clinical data. Comparison of the breathprint of a suspected subject to the breathcloud allows for a rapid decision on the presence or absence of a pathogen. PMID:24795745

Bos, Lieuwe D J; de Jong, Menno D; Sterk, Peter J; Schultz, Marcus J

2014-01-01

205

Knowledge and anticipated behavior of health care workers in response to an outbreak of pandemic influenza in Georgia  

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Full Text Available Background: Avian influenza has been documented in over 331 humans since 2003 with 203 associated deaths. Health Care Workers (HCWs have been shown to be at personal risk during other highly virulent outbreaks with a high attack rate. This study aimed to determine the magnitude and factors associated with absenteeism of hospital based health care workers (HCWs in Georgia associated with a potential highly virulent influenza pandemic.Methodology: This was a cross-sectional study of how HCWs responded to a potentially highly virulent influenza pandemic in two urban hospitals in Georgia. Hospital based physicians and nurses were studied. Data was collected utilizing a survey instrument. The survey was either self-administered or interviewer administered based upon the preference of the respondent.Results: There were 288 HCWs surveyed. The study suggested a 23% rate of worker absenteeism, predominately among women and nurses. The majority of the respondents (58.1%, mostly HCWs less than age 35, were opposed to forced isolation or quarantine of staff during a highly virulent influenza pandemic. Seventy-six percent of respondents correctly reported that the strain of virus that was responsible for the outbreaks in the neighboring countries was H5N1. Only 15.5% of respondents, however, correctly identified influenza as the culprit virus.Conclusions: The rate of work absenteeism suggested by this study represents a significant workforce reduction. There are specific groups who would choose not to attend work in the face of a flu pandemic. This information may allow planners to target these specific groups for education and social support services to encourage greater inclination to attend to clinical duties.

Maia Butsashvili,1 Wayne Triner,2 George Kamkamidze,1 Maia Kajaia,1 Louise-Anne McNutt.2

2007-12-01

206

Assessing secondary attack rates among household contacts at the beginning of the influenza A (H1N1) pandemic in Ontario, Canada, April-June 2009: A prospective, observational study  

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Abstract Background Understanding transmission dynamics of the pandemic influenza A (H1N1) virus in various exposure settings and determining whether transmissibility differed from seasonal influenza viruses was a priority for decision making on mitigation strategies at the beginning of the pandemic. The objective of this study was to estimate household secondary attack rates for pandemic influenza in a susceptible population where control measures had yet to be implemented.<...

Horn Maureen; Frenette Crystal; Carr Deborah J; Winter Anne-Luise; Badiani Tina; Lam Freda; Rosella Laura C; LaFreniere Marie; Rea Elizabeth; Johnson Ian; Whelan Michael; Savage Rachel; Dooling Kathleen; Varia Monali; Holt Anne-Marie

2011-01-01

207

Entry screening to delay local transmission of 2009 pandemic influenza A (H1N1  

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Full Text Available Abstract Background After the WHO issued the global alert for 2009 pandemic influenza A (H1N1, many national health agencies began to screen travelers on entry in airports, ports and border crossings to try to delay local transmission. Methods We reviewed entry screening policies adopted by different nations and ascertained dates of official report of the first laboratory-confirmed imported H1N1 case and the first laboratory-confirmed untraceable or 'local' H1N1 case. Results Implementation of entry screening policies was associated with on average additional 7-12 day delays in local transmission compared to nations that did not implement entry screening, with lower bounds of 95% confidence intervals consistent with no additional delays and upper bounds extending to 20-30 day additional delays. Conclusions Entry screening may lead to short-term delays in local transmission of a novel strain of influenza virus. The resources required for implementation should be balanced against the expected benefits of entry screening.

Wong Helen WC

2010-03-01

208

Characterization of H1N1 Swine Influenza Viruses Circulating in Canadian Pigs in 2009?  

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The 2009 pandemic H1N1 (pH1N1), of apparent swine origin, may have evolved in pigs unnoticed because of insufficient surveillance. Consequently, the need for surveillance of influenza viruses circulating in pigs has received added attention. In this study we characterized H1N1 viruses isolated from Canadian pigs in 2009. Isolates from May 2009 were comprised of hemagglutinin and neuraminidase (NA) genes of classical SIV origin in combination with the North American triple-reassortant internal...

Nfon, Charles K.; Berhane, Yohannes; Hisanaga, Tamiko; Zhang, Shunzhen; Handel, Katherine; Kehler, Helen; Labrecque, Olivia; Lewis, Nicola S.; Vincent, Amy L.; Copps, John; Alexandersen, Soren; Pasick, John

2011-01-01

209

Mutations in Polymerase Genes Enhanced the Virulence of 2009 Pandemic H1N1 Influenza Virus in Mice  

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Influenza A virus can infect a wide variety of animal species with illness ranging from mild to severe, and is a continual cause for concern. Genetic mutations that occur either naturally or during viral adaptation in a poorly susceptible host are key mechanisms underlying the evolution and virulence of influenza A virus. Here, the variants containing PA-A36T or PB2-H357N observed in the mouse-adapted descendants of 2009 pandemic H1N1 virus (pH1N1), A/Sichuan/1/2009 (SC), were characterized. ...

Zhu, Wenfei; Zhu, Yun; Qin, Kun; Yu, Zaijiang; Gao, Rongbao; Yu, Huiyan; Zhou, Jianfang; Shu, Yuelong

2012-01-01

210

Studies needed to address public health challenges of the 2009 H1N1 influenza pandemic: insights from modeling  

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The 2009 influenza pandemic (H1N1pdm) has completed its first wave in many northern and southern hemisphere populations and many northern hemisphere populations are reporting substantial activity indicating the start of a second wave this autumn. As the global epidemiology of this novel strain unfolds, substantial policy challenges will continue to present themselves for the next 12 to 18 months. Here, we anticipate six public health challenges and identify data that are required for public h...

2009-01-01

211

The scourge of Asian Flu: In utero exposure to pandemic influenza and the development of a cohort of British children  

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This paper examines the impact of in utero exposure to the Asian influenza pandemic of 1957 upon physical and cognitive development in childhood. Outcome data is provided by the National Child Development Study (NCDS), a panel study of a cohort of British children who were all potentially exposed in the womb. Epidemic effects are identified using geographic variation in a surrogate measure of the epidemic. Results indicate significant detrimental effects of the epidemic upon birth weight and ...

Kelly, Elaine

2009-01-01

212

Deterministic model for the role of antivirals in controlling the spread of the H1N1 influenza pandemic  

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A deterministic model is designed and used to theoretically assess the impact of antiviral drugs in controlling the spread of the 2009 swine influenza pandemic. In particular, the model considers the administration of the antivirals both as a preventive as well as a therapeutic agent. Rigorous analysis of the model reveals that its disease-free equilibrium is globally-asymptotically stable under certain conditions involving having the associated reproduction number less than unity. Fu...

Mudassar Imran; Malik, Mohammad T.; Garba, Salisu M.

2011-01-01

213

A Computer Simulation of Vaccine Prioritization, Allocation, and Rationing During the 2009 H1N1 Influenza Pandemic  

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In the Fall 2009, the University of Pittsburgh Models of Infectious Disease Agent Study (MIDAS) team employed an agent-based computer simulation model (ABM) of the greater Washington, DC, metropolitan region to assist the Office of the Assistant Secretary of Public Preparedness and Response, Department of Health and Human Services, to address several key questions regarding vaccine allocation during the 2009 H1N1 influenza pandemic, including comparing a vaccinating children (i.e., highest tr...

Lee, Bruce Y.; Brown, Shawn T.; Korch, George; Cooley, Philip C.; Zimmerman, Richard K.; Wheaton, William D.; Zimmer, Shanta M.; Grefenstette, John J.; Bailey, Rachel R.; Assi, Tina-marie; Burke, Donald S.

2010-01-01

214

Radiological and Clinical Characteristics of a Military Outbreak of Pandemic H1N1 2009 Influenza Virus Infection  

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To describe detailed clinical and radiological features of the pandemic H1N1 2009 influenza viral infection among healthy young males in a semiclosed institutionalized setting. A total of 18 patients confirmed with the pandemic H1N1 2009 influenza virus infection from July 18 to July 30, 2009 were enrolled in this study. Each patient underwent an evaluation to determine detailed clinical and radiological features. All patients presented with high fever (> 38.0..C), with accompanying symptoms of cough, rhinorrhea, sore throat, myalgia and diarrhea, and increased C-reactive protein (CRP) values with no leukocytosis nor elevated erythrocyte sedimentation rate (ESR). All patients, including one patient who progressed into acute respiratory distress syndrome, were treated with oseltamivir phosphate and quickly recovered from their symptoms. Chest radiographs showed abnormalities of small nodules and lobar consolidation in only two out of 18 patients. However, six of 12 patients who underwent thin-section CT examinations showed abnormal findings for small ground-glass opacities (GGOs) in addition to poorly-defined nodules with upper lobe predominance. In a population of healthy young adults, elevated CRP with normal ESR and white blood cell levels combined with GGOs and nodules on thin section CT scans may indicate early signs of infection by the pandemic H1N1 2009 influenza virus

Yun, Tae Jin; Kwon, Gu Jin; Oh, Mi Kyeong; Woo, Sung Koo; Park, Seung Hoon; Choi, Seung Hong; Lee, Hyun Ju; Goo, Jin Mo; Yim, Jae Joon; Kim, Jong Sung; Park, Chang Min [Seoul National University Hospital, Seoul (Korea, Republic of)

2010-08-15

215

Severe influenza cases in paediatric intensive care units in Germany during the pre-pandemic seasons 2005 to 2008  

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Full Text Available Abstract Background Data on complications in children with seasonal influenza virus infection are limited. We initiated a nation-wide three-year surveillance of children who were admitted to a paediatric intensive care unit (PICU with severe seasonal influenza. Methods From October 2005 to July 2008, active surveillance was performed using an established reporting system for rare diseases (ESPED including all paediatric hospitals in Germany. Cases to be reported were hospitalized children Results Twenty severe influenza-associated cases were reported from 14 PICUs during three pre-pandemic influenza seasons (2005-2008. The median age of the patients (12 males/8 females was 7.5 years (range 0.1-15 years. None had received vaccination against influenza. In 14 (70% patients, the infection had been caused by influenza A and in five (25% by influenza B; in one child (5% the influenza type was not reported. Patients spent a median of 19 (IQR 12-38 days in the hospital and a median of 11 days (IQR 6-18 days in the PICU; 10 (50% needed mechanical ventilation. Most frequent diagnoses were influenza-associated pneumonia (60%, bronchitis/bronchiolitis (30%, encephalitis/encephalopathy (25%, secondary bacterial pneumonia (25%, and ARDS (25%. Eleven (55% children had chronic underlying medical conditions, including 8 (40% with chronic pulmonary diseases. Two influenza A- associated deaths were reported: i an 8-year old boy with pneumococcal encephalopathy following influenza infection died from cerebral edema, ii a 14-year-old boy with asthma bronchiale, cardiac malformation and Addison's disease died from cardiac and respiratory failure. For nine (45% patients, possibly permanent sequelae were reported (3 neurological, 3 pulmonary, 3 other sequelae. Conclusions Influenza-associated pneumonia and secondary bacterial infections are relevant complications of seasonal influenza in Germany. The incidence of severe influenza cases in PICUs was relatively low. This may be either due to the weak to moderate seasonal influenza activity during the years 2005 to 2008 or due to under-diagnosis of influenza by physicians. Fifty% of the observed severe cases might have been prevented by following the recommendations for vaccination of risk groups in Germany.

Liese Johannes G

2011-08-01

216

Severe pandemic H1N1 and seasonal influenza in children and young adults with sickle cell disease.  

Science.gov (United States)

Influenza causes excess morbidity in sickle cell disease (SCD). H1N1 pandemic influenza has been severe in children. To compare H1N1 with seasonal influenza in SCD (patients younger than 22), we reviewed medical records (1993-2009). We identified 123 cases of laboratory-confirmed influenza (94 seasonal, 29 H1N1). Those with seasonal influenza were younger (median 4.4 vs 8.7 years old, P = .006) and had less asthma (24% vs 56%, P = .002). Those with H1N1 influenza more often had acute chest syndrome (ACS; 34% vs 13%, P = .01) and required intensive care (17% vs 3%, P = .02), including mechanical ventilation (10% vs 0%, P = .02). In multivariate analysis, older age (odds ratio [OR] 1.1 per year, P = .04) and H1N1 influenza (OR 3.0, P = .04) were associated with ACS, and older age (OR 1.1 per year, P = .02) and prior ACS (OR 3.3 per episode in last year, P SCD and should be prevented. PMID:20656929

Strouse, John J; Reller, Megan E; Bundy, David G; Amoako, Martha; Cancio, Maria; Han, Rachel N; Valsamakis, Alexandra; Casella, James F

2010-11-01

217

An Analysis of 332 Fatalities Infected with Pandemic 2009 Influenza A (H1N1) in Argentina  

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Background The apparent high number of deaths in Argentina during the 2009 pandemic led to concern that the influenza A H1N1pdm disease was different there. We report the characteristics and risk factors for influenza A H1N1pdm fatalities. Methods We identified laboratory-confirmed influenza A H1N1pdm fatalities occurring during June-July 2009. Physicians abstracted data on age, sex, time of onset of illness, medical history, clinical presentation at admission, laboratory, treatment, and outcomes using standardize questionnaires. We explored the characteristics of fatalities according to their age and risk group. Results Of 332 influenza A H1N1pdm fatalities, 226 (68%) were among persons aged <50 years. Acute respiratory failure was the leading cause of death. Of all cases, 249 (75%) had at least one comorbidity as defined by Advisory Committee on Immunization Practices. Obesity was reported in 32% with data and chronic pulmonary disease in 28%. Among the 40 deaths in children aged <5 years, chronic pulmonary disease (42%) and neonatal pathologies (35%) were the most common co-morbidities. Twenty (6%) fatalities were among pregnant or postpartum women of which only 47% had diagnosed co-morbidities. Only 13% of patients received antiviral treatment within 48 hours of symptom onset. None of children aged <5 years or the pregnant women received antivirals within 48 h of symptom onset. As the pandemic progressed, the time from symptom-onset to medical care and to antiviral treatment decreased significantly among case-patients who subsequently died (p<0.001). Conclusion Persons with co-morbidities, pregnant and who received antivirals late were over-represented among influenza A H1N1pdm deaths in Argentina, though timeliness of antiviral treatment improved during the pandemic. PMID:22506006

Balanzat, Ana M.; Hertlein, Christian; Apezteguia, Carlos; Bonvehi, Pablo; Camera, Luis; Gentile, Angela; Rizzo, Oscar; Gomez-Carrillo, Manuel; Coronado, Fatima; Azziz-Baumgartner, Eduardo; Chavez, Pollyanna R.; Widdowson, Marc-Alain

2012-01-01

218

Coordination of multidisciplinary resources for vaccination of egg-allergic individuals during an H1N1 (novel) influenza pandemic.  

Science.gov (United States)

Egg allergy is a contraindication for influenza vaccination because of the presence of trace egg protein. Although recent reports suggest that egg-allergic individuals can be safely immunized with seasonal influenza vaccine, the safety of H1N1 influenza vaccine in this context has not previously been reported. This study was designed to investigate how to safely immunize high-risk populations during the H1N1 influenza pandemic for whom the vaccine would be contraindicated. Vaccination of egg-allergic children was conducted at a large, multispecialty practice. Pediatricians raised awareness of vaccination and referred egg-allergic individuals to allergists. Allergists performed skin testing to H1N1 vaccine and, if negative, performed graded vaccine desensitizations in the office. Mass immunization of egg-allergic individuals was achieved within a 3-week period after receipt of vaccine. Sixty-three children (average age, 3.7 years) were evaluated and skin tested to the H1N1 influenza vaccine. All had a clinical history of egg allergy and recent positive skin-prick to egg. All had negative skin-prick test to the H1N1 vaccine and received graded challenge with three divided doses. All 62 children were successfully immunized without allergic reactions. Vaccination of egg-allergic individuals during a pandemic can be safely and efficiently accomplished with the coordination of multidisciplinary resources. Although this was conducted at a multispecialty practice, we believe that this invaluable public health service can be done outside of this context. Allergists, with the help of local pediatricians and urgent care centers or hospitals, can effectively mobilize to help protect the most vulnerable populations during pandemics. PMID:20943012

Pien, Gary C; LeBenger, Kerry S; Carotenuto, Danielle R; Difilippi, Michele; Scolpino, Denise; Simmons, Jane M; Barrett, Cindy; Brenner, Robert W

2010-01-01

219

From press release to news: mapping the framing of the 2009 H1N1 A influenza pandemic.  

Science.gov (United States)

Pandemics challenge conventional assumptions about health promotion, message development, community engagement, and the role of news media. To understand the use of press releases in news coverage of pandemics, this study traces the development of framing devices from a government public health agency's press releases to news stories about the 2009 H1N1 A influenza pandemic. The communication management of the H1N1 pandemic, an international news event with local implications, by the Singapore government is a rich locus for understanding the dynamics of public relations, health communication, and journalism. A content analysis shows that the evolution of information from press release to news is marked by significant changes in media frames, including the expansion and diversification in dominant frames and emotion appeals, stronger thematic framing, more sources of information, conversion of loss frames into gain frames, and amplification of positive tone favoring the public health agency's position. Contrary to previous research that suggests that government information subsidies passed almost unchanged through media gatekeepers, the news coverage of the pandemic reflects journalists' selectivity in disseminating the government press releases and in mediating the information flow and frames from the press releases. PMID:22439616

Lee, Seow Ting; Basnyat, Iccha

2013-01-01

220

Infection Dynamics of Pandemic 2009 H1N1 Influenza Virus in a Two-Site Swine Herd.  

Science.gov (United States)

Influenza A viruses are common causes of respiratory disease in pigs and can be transmitted among multiple host species, including humans. The current lack of published information on infection dynamics of influenza viruses within swine herds hinders the ability to make informed animal health, biosecurity and surveillance programme decisions. The objectives of this serial cross-sectional study were to describe the infection dynamics of influenza virus in a two-site swine system by estimating the prevalence of influenza virus in animal subpopulations at the swine breeding herd and describing the temporal pattern of infection in a selected cohort of growing pigs weaned from the breeding herd. Nasal swab and blood samples were collected at approximately 30-day intervals from the swine breeding herd (Site 1) known to be infected with pandemic 2009 H1N1 influenza virus. Sows, gilts and neonatal pigs were sampled at each sampling event, and samples were tested for influenza virus genome using matrix gene RRT-PCR. Influenza virus was detected in neonatal pigs, but was not detected in sow or gilt populations via RRT-PCR. A virus genetically similar to that detected in the neonatal pig population at Site 1 was also detected at the wean-to-finish site (Site 2), presumably following transportation of infected weaned pigs. Longitudinal sampling of nasal swabs and oral fluids revealed that influenza virus persisted in the growing pigs at Site 2 for at least 69 days. The occurrence of influenza virus in neonatal pigs, but not breeding females, at Site 1 emphasizes the potential for virus maintenance in this dynamic subpopulation, the importance of including this subpopulation in surveillance programmes and the potential transport of influenza virus between sites via the movement of weaned pigs. PMID:23294593

Allerson, M W; Davies, P R; Gramer, M R; Torremorell, M

2014-12-01

 
 
 
 
221

Oseltamivir compounding in the hospital pharmacy during the (H1N1 influenza pandemic  

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Full Text Available AIMS: Pandemics impose large demands on the health care system. The supply of appropriate chemotherapeutic agents, namely oseltamivir solution, presented a serious challenge in the recent influenza pandemic. This study reports on the rational series of pharmacotechnical steps that were followed to appropriately handle bulk oseltamivir powder to meet the increased demand. METHODS: During a six-week period in August and September of 2009, a task force was created in the Central Pharmacy of Hospital das Clínicas to convert imported oseltamivir phosphate into ready-to-use solution for utilization by physicians and public health authorities. The protocol included dissolution, physico-chemical tests and the bottling of a liquid microdose formulation for emergency room and outpatient dispensing with adequate quality control during all phases. RESULTS: The successful production routine was based on a specially designed flowchart according to which a batch of 33210 g of oseltamivir powder was converted into 32175 solution units during the aforementioned period with a net loss of only 2.6%. The end products were bottles containing 50 ml of 15 mg/mL oseltamivir solution. The measured concentration was stable and accurate (97.5% - 102.0% of the nominal value. The drug was prescribed as both a prophylactic and therapeutic agent. DISCUSSION: Hospital pharmacies are conventionally engaged in the manipulation of medical prescriptions and specialty drugs. They are generally responsible for only small-scale equipment used for manufacturing and quality-control procedures. The compounding of oseltamivir was a unique effort dictated by exceptional circumstances. CONCLUSION: The shortage of oseltamivir solution for clinical use was solved by emergency operationalization of a semi-industrial process in which bulk powder was converted into practical vials for prompt delivery.

Márcia Lúcia de Mário Marin

2010-01-01

222

Oseltamivir compounding in the hospital pharmacy during the (H1N1) influenza pandemic  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in english AIMS: Pandemics impose large demands on the health care system. The supply of appropriate chemotherapeutic agents, namely oseltamivir solution, presented a serious challenge in the recent influenza pandemic. This study reports on the rational series of pharmacotechnical steps that were followed to a [...] ppropriately handle bulk oseltamivir powder to meet the increased demand. METHODS: During a six-week period in August and September of 2009, a task force was created in the Central Pharmacy of Hospital das Clínicas to convert imported oseltamivir phosphate into ready-to-use solution for utilization by physicians and public health authorities. The protocol included dissolution, physico-chemical tests and the bottling of a liquid microdose formulation for emergency room and outpatient dispensing with adequate quality control during all phases. RESULTS: The successful production routine was based on a specially designed flowchart according to which a batch of 33210 g of oseltamivir powder was converted into 32175 solution units during the aforementioned period with a net loss of only 2.6%. The end products were bottles containing 50 ml of 15 mg/mL oseltamivir solution. The measured concentration was stable and accurate (97.5% - 102.0% of the nominal value). The drug was prescribed as both a prophylactic and therapeutic agent. DISCUSSION: Hospital pharmacies are conventionally engaged in the manipulation of medical prescriptions and specialty drugs. They are generally responsible for only small-scale equipment used for manufacturing and quality-control procedures. The compounding of oseltamivir was a unique effort dictated by exceptional circumstances. CONCLUSION: The shortage of oseltamivir solution for clinical use was solved by emergency operationalization of a semi-industrial process in which bulk powder was converted into practical vials for prompt delivery.

Márcia Lúcia de Mário, Marin; Bruno Barbosa do Carmo, Oliveira; Sonia Lucena, Cipriano; Carlos Alberto, Suslik; Joel, Faintuch.

1081-10-01

223

Oseltamivir compounding in the hospital pharmacy during the (H1N1) influenza pandemic  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in english AIMS: Pandemics impose large demands on the health care system. The supply of appropriate chemotherapeutic agents, namely oseltamivir solution, presented a serious challenge in the recent influenza pandemic. This study reports on the rational series of pharmacotechnical steps that were followed to a [...] ppropriately handle bulk oseltamivir powder to meet the increased demand. METHODS: During a six-week period in August and September of 2009, a task force was created in the Central Pharmacy of Hospital das Clínicas to convert imported oseltamivir phosphate into ready-to-use solution for utilization by physicians and public health authorities. The protocol included dissolution, physico-chemical tests and the bottling of a liquid microdose formulation for emergency room and outpatient dispensing with adequate quality control during all phases. RESULTS: The successful production routine was based on a specially designed flowchart according to which a batch of 33210 g of oseltamivir powder was converted into 32175 solution units during the aforementioned period with a net loss of only 2.6%. The end products were bottles containing 50 ml of 15 mg/mL oseltamivir solution. The measured concentration was stable and accurate (97.5% - 102.0% of the nominal value). The drug was prescribed as both a prophylactic and therapeutic agent. DISCUSSION: Hospital pharmacies are conventionally engaged in the manipulation of medical prescriptions and specialty drugs. They are generally responsible for only small-scale equipment used for manufacturing and quality-control procedures. The compounding of oseltamivir was a unique effort dictated by exceptional circumstances. CONCLUSION: The shortage of oseltamivir solution for clinical use was solved by emergency operationalization of a semi-industrial process in which bulk powder was converted into practical vials for prompt delivery.

Márcia Lúcia de Mário, Marin; Bruno Barbosa do Carmo, Oliveira; Sonia Lucena, Cipriano; Carlos Alberto, Suslik; Joel, Faintuch.

224

U.S. airport entry screening in response to pandemic influenza: Modeling and analysis  

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A stochastic discrete event simulation model was developed to assess the effectiveness of passenger screening for Pandemic Influenza (PI) at U.S. airport foreign entry. Methods: International passengers arriving at 18 U.S. airports from Asia, Europe, South America, and Canada were assigned to one of three states: not infected, infected with PI, infected with other respiratory illness. Passengers passed through layered screening then exited the model. 80% screening effectiveness was assumed for symptomatic passengers; 6% asymptomatic passengers. Results: In the first 100 days of a global pandemic, U.S. airport screening would evaluate over 17 M passengers with 800 K secondary screenings. 11,570 PI infected passengers (majority asymptomatic) would enter the U.S. undetected from all 18 airports. Foreign airport departure screening significantly decreased the false negative (infected/undetected) passengers. U.S. attack rates: no screening (26.9%-30.9%); screening (26.4%-30.6%); however airport screening results in 800 K-1.8 M less U.S. PI cases; 16 K-35 K less deaths (2% fatality rate). Antiviral medications for travel contact prophylaxis (10 contacts/PI passenger) were high - 8.8 M. False positives from all 18 airports: 100-200/day. Conclusions: Foreign shore exit screening greatly reduces numbers of PI infected passengers. U.S. airport screening identifies 50% infected individuals; efficacy is limited by the asymptomatic PI infected. Screening will not significantly delay arrival of PI via international air transport, but will reduce the rate of new US cases and subsequent deaths. (C) 2009 Elsevier Ltd. All rights reserved.

Malone, John D. [Uniformed Services University of the Health Sciences (USUHS); Brigantic, Robert [Pacific Northwest National Laboratory (PNNL); Muller, G. [Pacific Northwest National Laboratory (PNNL); Gadgil, Ashok [Lawrence Berkeley National Laboratory (LBNL); Delp, Woody [Lawrence Berkeley National Laboratory (LBNL); McMahon, Benjamin H. [Los Alamos National Laboratory (LANL); Lee, Russell [ORNL; Kulesz, Jim [Oak Ridge National Laboratory (ORNL); Mihelic, F. Matthew [Oak Ridge National Laboratory (ORNL)

2009-01-01

225

The Spanish flu in Uppsala, clinical and epidemiological impact of the influenza pandemic 1918–1919 on a Swedish county  

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Full Text Available Introduction and aim: The Spanish flu reached Sweden in June 1918, and at least one-third of the population (then 5.8 million became infected. Some 34,500 persons (5.9 per 1,000 people died from influenza during the first year of the pandemic (when acute pneumonia is included, the number of deaths rose to 7.1 per 1,000 people. In this historical look back at the pandemic, our aim was to review the epidemiological impact on the Swedish county of Uppsala, the clinical outcomes and the economic impact on the regional hospital; a relevant backgound to consider the impact of a future virulent pandemic. We also focused on how the pandemic was perceived by the medical community and by health care authorities. Methods: Health care reports, statistics, daily newspapers, medical journals, and records of patients treated for influenza at the Uppsala Academic Hospital from July 1918 to June 1919 were included in our review. Results: An influenza related mortality rate of 693 persons (5.1 per 1,000 people was reported in the Uppsala region from 1918–1919; from July 1918 to June 1919, 384 patients were treated for influenza at the Uppsala Academic Hospital. The first wave peaked in November 1918 with case fatality rates up to 30%; a second wave peaked in April 1919 with a lower rate of mortality. Of the patients treated, a total of 66 died. Of these, 60% were 20–29 years of age, and 85% were less than 40 years old. Autopsy reports revealed pneumonia in 89% of the cases; among these, 47% were hemorrhagic, 18% were bilateral, and 45% had additional extrapulmonary organ involvement. Signs of severe viral disease were documented, but secondary bacterial disease was the primary cause of death in the majority of cases. Conclusion: The epidemiologic and pathologic results were in accordance with other publications of this time period. The costs of running the hospital doubled from 1917 to 1920 and then reversed by 45%. Today, an influenza pandemic of the same virulence would paralyze health care systems and result in extremely high financial costs and rates of mortality.

Jonas Holtenius

2014-01-01

226

Los virus Influenza y la nueva pandemia A/H1N1 / Influenza virus and the new Influenza A/H1N1 pandemics  

Scientific Electronic Library Online (English)

Full Text Available SciELO Peru | Language: Spanish Abstract in spanish Los virus Influenza pertenecen a la familia Orthomyxoviridae, virus con genoma RNA de sentido negativo segmentado. Los virus influenza tipo A infectan a humanos y otros organismos, y son los agentes causantes de influenza en humanos. Resaltan entre sus principales proteínas la Hemaglutinina y la Neu [...] raminidasa, que son utilizadas en la clasificación de los miembros de este grupo. Estos virus mutan continuamente, exhibiendo patrones muy estudiados, como el cambio y la deriva antigénica, siendo uno de los principales eventos de recombinación el reordenamiento. Todos los subtipos se encuentran en aves acuáticas silvestres, aunque se han encontrado otros hospederos, como equinos, visones, ballenas, focas, cerdos, gallinas y pavos, entre otros. Tanto las aves salvajes, las aves domésticas y el cerdo juegan un rol fundamental en la adaptación progresiva del virus al hospedero humano. Aunque los subtipos H2N2 y H3N2 han sido muy comunes, el subtipo H1N1 ha reemergido con mutaciones que le han permitido alcanzar el estado de pandemia en 2009. Este nuevo virus surge de un virus generado por triple reordenamiento con el virus humano, porcino norteamericano y aviar, conteniendo a su vez segmentos génicos de virus influenza porcina euroasiática. Esto ha hecho que el virus presente una enfermedad humana moderada y solamente severa y hasta letal en casos de individuos con condiciones médicas previas. A nivel mundial ha causado más de 134,510 casos y en el Perú alcanza cerca de 3,700 casos. El estado actual indica que la pandemia está por llegar a su pico máximo en el Perú, debido a la alta morbilidad del virus coincidente con la estación más fría del año. Es importante contener al máximo la dispersión del virus, ya que cuanto mayor sea el número de personas que infecte, el mismo estará sometido a un mayor número de eventos de recombinación genética por reordenamiento con virus influenza humanos previos y esto puede condicionar a la aparición todavía de nuevas cepas, para las que el sistema inmune podría no estar preparado a nivel poblacional. Abstract in english The Influenza virus belongs to the Orthomyxoviridae family, viruses with a negative sense segmented RNA genome. The influenza virus type A infects humans and other organisms, and is the causative agent of human influenza. Hemagglutinin and Neuraminidase stand out among other proteins, and are used i [...] n the classification of the members of this group. These viruses mutate continuously, with patterns long studied, the antigenic shift and the antigenic drift, with one major event of recombination called reassortment. All subtypes exist in wild aquatic birds, although other hosts can be found, such as horses, minks, whales, seals, pigs, hens and turkeys, among others. As part of its progressive adaptation to the human host, wild birds and poultry play a fundamental role as well as swine. Although H2N2 and H3N2 subtypes have been very common among the human population, H1N1 subtype has re-emerged with mutations that have allowed it to reach the pandemics state in 2009. This new virus has a close ancestor in a triple reassortant virus from a human influenza virus, a classic influenza swine virus and an avian influenza virus, and contains as well genetic segments from a Euroasian swine influenza virus. This has caused that the virus displays a mild disease, only severe or lethal in individuals with previous medical history. At worldwide level it has caused more than 134.510 cases and in Peru they are close to 3.700. The current state indicates that in Peru the pandemics is about to reach its peak due to the high morbidity of the virus and coldest season of the year. The containment of this virus is important, since the greater the number of people infected, the greater the number of reassortment events the virus will be subjected to, with previous human influenza viruses, and may determine the appearance of new strains, for which the immune system might not be prepared at t

Miguel, Talledo; Kattya, Zumaeta.

2009-12-01

227

Los virus Influenza y la nueva pandemia A/H1N1 / Influenza virus and the new Influenza A/H1N1 pandemics  

Scientific Electronic Library Online (English)

Full Text Available SciELO Peru | Language: Spanish Abstract in spanish Los virus Influenza pertenecen a la familia Orthomyxoviridae, virus con genoma RNA de sentido negativo segmentado. Los virus influenza tipo A infectan a humanos y otros organismos, y son los agentes causantes de influenza en humanos. Resaltan entre sus principales proteínas la Hemaglutinina y la Neu [...] raminidasa, que son utilizadas en la clasificación de los miembros de este grupo. Estos virus mutan continuamente, exhibiendo patrones muy estudiados, como el cambio y la deriva antigénica, siendo uno de los principales eventos de recombinación el reordenamiento. Todos los subtipos se encuentran en aves acuáticas silvestres, aunque se han encontrado otros hospederos, como equinos, visones, ballenas, focas, cerdos, gallinas y pavos, entre otros. Tanto las aves salvajes, las aves domésticas y el cerdo juegan un rol fundamental en la adaptación progresiva del virus al hospedero humano. Aunque los subtipos H2N2 y H3N2 han sido muy comunes, el subtipo H1N1 ha reemergido con mutaciones que le han permitido alcanzar el estado de pandemia en 2009. Este nuevo virus surge de un virus generado por triple reordenamiento con el virus humano, porcino norteamericano y aviar, conteniendo a su vez segmentos génicos de virus influenza porcina euroasiática. Esto ha hecho que el virus presente una enfermedad humana moderada y solamente severa y hasta letal en casos de individuos con condiciones médicas previas. A nivel mundial ha causado más de 134,510 casos y en el Perú alcanza cerca de 3,700 casos. El estado actual indica que la pandemia está por llegar a su pico máximo en el Perú, debido a la alta morbilidad del virus coincidente con la estación más fría del año. Es importante contener al máximo la dispersión del virus, ya que cuanto mayor sea el número de personas que infecte, el mismo estará sometido a un mayor número de eventos de recombinación genética por reordenamiento con virus influenza humanos previos y esto puede condicionar a la aparición todavía de nuevas cepas, para las que el sistema inmune podría no estar preparado a nivel poblacional. Abstract in english The Influenza virus belongs to the Orthomyxoviridae family, viruses with a negative sense segmented RNA genome. The influenza virus type A infects humans and other organisms, and is the causative agent of human influenza. Hemagglutinin and Neuraminidase stand out among other proteins, and are used i [...] n the classification of the members of this group. These viruses mutate continuously, with patterns long studied, the antigenic shift and the antigenic drift, with one major event of recombination called reassortment. All subtypes exist in wild aquatic birds, although other hosts can be found, such as horses, minks, whales, seals, pigs, hens and turkeys, among others. As part of its progressive adaptation to the human host, wild birds and poultry play a fundamental role as well as swine. Although H2N2 and H3N2 subtypes have been very common among the human population, H1N1 subtype has re-emerged with mutations that have allowed it to reach the pandemics state in 2009. This new virus has a close ancestor in a triple reassortant virus from a human influenza virus, a classic influenza swine virus and an avian influenza virus, and contains as well genetic segments from a Euroasian swine influenza virus. This has caused that the virus displays a mild disease, only severe or lethal in individuals with previous medical history. At worldwide level it has caused more than 134.510 cases and in Peru they are close to 3.700. The current state indicates that in Peru the pandemics is about to reach its peak due to the high morbidity of the virus and coldest season of the year. The containment of this virus is important, since the greater the number of people infected, the greater the number of reassortment events the virus will be subjected to, with previous human influenza viruses, and may determine the appearance of new strains, for which the immune system might not be prepared at t

Miguel, Talledo; Kattya, Zumaeta.

228

Scaling in the Global Spreading Patterns of Pandemic Influenza A and the Role of Control: Empirical Statistics and Modeling  

CERN Document Server

The pandemic of influenza A (H1N1) is a serious on-going global public crisis. Understanding its spreading dynamics is of fundamental importance for both public health and scientific researches. In this paper, we investigate the spreading patterns of influenza A and find the Zipf's law of the distributions of confirmed cases in different levels. Similar scaling properties are also observed for severe acute respiratory syndrome (SARS) and bird cases of avian influenza (H5N1). To explore the underlying mechanism, a model considering the control effects on both the local growth and transregional transmission is proposed, which shows that the strong control effects are responsible for the scaling properties. Although strict control measures for interregional travelers are helpful to delay the outbreak in the regions without local cases, our analysis suggests that the focus should be turned to local prevention after the outbreak of local cases. This work provides not only a deeper understanding of the generic mech...

Han, Xiao-Pu; Zhou, Chang-Song; Zhou, Tao; Zhu, Jun-Fang

2009-01-01

229

Military and Military Medical Support in Highly Pathogenic Avian Influenza (HPAI/H5N1) Pandemic Scenario  

International Nuclear Information System (INIS)

Avian influenza (Bird flu) is a highly contagious viral disease affecting mainly chickens, turkeys, ducks, other birds and mammals. Reservoirs for HPAI /H5N1 virus are shore birds and waterfowl (asymptomatic, excrete virus in feces for a long periods of time), live bird markets and commercial swine facilities. Virus tends to cycle between pigs and birds. HPAI (H5N1) virus is on every 'top ten' list available for potential agricultural bio-weapon agents. The threat of a HPAI/H5N1 pandemic is a definitively global phenomenon and the response must be global. A number of National plans led to various measures of preventing and dealing with epidemics/pandemics. Lessons learned form the pandemic history indicated essential role of military and military medical support to civil authorities in a crisis situation. Based on International Military Medical Avian Influenza Pandemic workshop (Vienna 2006), an expected scenario would involve 30-50% outpatients, 20-30% hospital admission, 2-3% deaths, 10-20% complicated cases. Activities of civil hospital may be reduced by 50%. Benefits of military support could be in: Transportation of patients (primarily by air); Mass vaccination and provision of all other preventive measures (masks, Tamiflu); Restriction of movements; Infection control of health care facilities; Field hospitals for triage and quarantine, military barracks to treat milder cases and military hospitals for severe cases; Deal with corpses; Stockpiling (vaccines, antiviral, antibiotics, protective equipment, supplies); Training; Laboratories; Ensure public safety, etc. With the aim of minimizing the risk of a pandemic spread by means of rapid and uncomplicated cooperation, an early warning system has to be established to improve surveillance, improve international contacts (WHO, ECDC, CDC), establish Platform for sharing information, close contacts of national and international military and civilian surveillance networks and databases, cooperation between military and civilian labs (external quality control). (author)

230

Polymorphisms in the haemagglutinin gene influenced the viral shedding of pandemic 2009 influenza virus in swine.  

Science.gov (United States)

Interactions between the viral surface glycoprotein haemagglutinin (HA) and the corresponding receptors on host cells is one important aspect of influenza virus infection. Mutations in HA have been described to affect pathogenicity, antigenicity and the transmission of influenza viruses. Here, we detected polymorphisms present in HA genes of two pandemic 2009 H1N1 (H1N1pdm09) isolates, A/California/04/2009 (Ca/09) and A/Mexico/4108/2009 (Mx/09), that resulted in amino acid changes at positions 186 (S to P) and 194 (L to I) of the mature HA1 protein. Although not reported in the published H1N1pdm09 consensus sequence, the P186 genotype was more readily detected in primary infected and contact-naïve pigs when inoculated with a heterogeneous mixed stock of Ca/09. Using reverse genetics, we engineered Ca/09 and Mx/09 genomes by introducing Ca/09 HA with two naturally occurring variants expressing S186/I194 (HA-S/I) and P186/L194 (HA-P/L), respectively. The Ca/09 HA with the combination of P186/L194 with either the Ca/09 or Mx/09 backbone resulted in higher and prolonged viral shedding in naïve pigs. This efficiency appeared to be more likely through an advantage in cell surface attachment rather than replication efficiency. Although these mutations occurred within the receptor-binding pocket and the Sb antigenic site, they did not affect serological cross-reactivity. Relative increases of P186 in publicly available sequences from swine H1N1pdm09 viruses supported the experimental data, indicating this amino acid substitution conferred an advantage in swine. PMID:25127710

Lorusso, Alessio; Ciacci-Zanella, Janice R; Zanella, Eraldo L; Pena, Lindomar; Perez, Daniel R; Lager, Kelly M; Rajão, Daniela S; Loving, Crystal L; Kitikoon, Pravina; Vincent, Amy L

2014-12-01

231

Impact on Pregnancies in South Brazil from the Influenza A (H1N1) Pandemic: Cohort Study  

Science.gov (United States)

Introduction The emergence of a new subtype of the influenza virus in 2009 generated interest in the international medical community, the media, and the general population. Pregnant women are considered to be a group at risk of serious complications related to the H1N1 influenza virus. The aim of this study was to evaluate the outcomes and teratogenic effects of pregnancies exposed to the H1N1 virus during the Influenza A epidemic that occurred in the state of Rio Grande do Sul in 2009. Methods This is an uncontrolled prospective cohort study of pregnant women with suspected symptoms of Influenza A who were reported in the Information System for Notifiable Diseases – Influenza (SINAN-Influenza) during the epidemic of 2009 (database from the state of Rio Grande do Sul, Brazil). There were 589 cases of pregnant women with suspected infection. Among these, 243 were tested by PCR and included in the analysis. The main outcome measures were: maternal deaths, pregnancy outcome, stillbirths, premature births, low birth weight, congenital malformations, and odds ratios for H1N1+ and non-H1N1 pregnant women. Results There were one hundred and sixty-three (67%) confirmed cases of H1N1, 34 cases (14%) of seasonal Influenza A and 46 (19%) who were negative for Influenza A. There was no difference between the three groups in clinical parameters of the disease. There were 24 maternal deaths — 18 of them had H1N1. There were 8 stillbirths — 5 were children of H1N1 infected mothers. There were no differences in perinatal outcomes. Conclusions The present data do not indicate an increase in teratogenic risk from exposure to the influenza A (H1N1) virus. These results will help to strengthen the data and clarify the health issues that arose after the pandemic. PMID:24558404

da Silva, Andre Anjos; Ranieri, Tani Maria Schilling; Torres, Fernanda Duarte; Vianna, Fernanda Sales Luiz; Paniz, Graziella Rangel; Sanseverino, Paula Baptista; Picon, Paulo Dornelles; de Azevedo, Pietro Baptista; Costa, Marta Haas; Schuler-Faccini, Lavinia; Sanseverino, Maria Teresa Vieira

2014-01-01

232

Productive infection of human skeletal muscle cells by pandemic and seasonal influenza A(H1N1) viruses.  

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Besides the classical respiratory and systemic symptoms, unusual complications of influenza A infection in humans involve the skeletal muscles. Numerous cases of acute myopathy and/or rhabdomyolysis have been reported, particularly following the outbreak of pandemic influenza A(H1N1) in 2009. The pathogenesis of these influenza-associated myopathies (IAM) remains unkown, although the direct infection of muscle cells is suspected. Here, we studied the susceptibility of cultured human primary muscle cells to a 2009 pandemic and a 2008 seasonal influenza A(H1N1) isolate. Using cells from different donors, we found that differentiated muscle cells (i. e. myotubes) were highly susceptible to infection by both influenza A(H1N1) isolates, whereas undifferentiated cells (i. e. myoblasts) were partially resistant. The receptors for influenza viruses, ?2-6 and ?2-3 linked sialic acids, were detected on the surface of myotubes and myoblasts. Time line of viral nucleoprotein (NP) expression and nuclear export showed that the first steps of the viral replication cycle could take place in muscle cells. Infected myotubes and myoblasts exhibited budding virions and nuclear inclusions as observed by transmission electron microscopy and correlative light and electron microscopy. Myotubes, but not myoblasts, yielded infectious virus progeny that could further infect naive muscle cells after proteolytic treatment. Infection led to a cytopathic effect with the lysis of muscle cells, as characterized by the release of lactate dehydrogenase. The secretion of proinflammatory cytokines by muscle cells was not affected following infection. Our results are compatible with the hypothesis of a direct muscle infection causing rhabdomyolysis in IAM patients. PMID:24223983

Desdouits, Marion; Munier, Sandie; Prevost, Marie-Christine; Jeannin, Patricia; Butler-Browne, Gillian; Ozden, Simona; Gessain, Antoine; Van Der Werf, Sylvie; Naffakh, Nadia; Ceccaldi, Pierre-Emmanuel

2013-01-01

233

Pandemic Influenza A (H1N1 2009 in India: Duration of virus shedding in patients under antiviral treatment  

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Full Text Available Background: National Centre for Disease Control (NCDC, Delhi, is a national nodal centre for surveillance of pandemic Influenza A (H1N1 in India. The present study was undertaken to see the period of infectivity in positive cases undergoing antiviral therapy. Objective: To assess the duration of virus shedding by real-time polymerase chain reaction (real-time PCR in some of the positive patients taking Oseltamivir treatment. Materials and Methods: Clinical samples (throat swabs, nasal swabs and nasopharyngeal swabs collected by the clinicians from patients quarantined in government hospitals in different parts of India are being sent to the designated reference laboratory at Delhi for screening presence of pandemic Influenza virus. The samples are tested by Real-Time PCR using CDC recommended reagents and protocol for confirmation of the H1N1 novel influenza virus. In 150 of the positive cases, we requested the clinicians to send samples for 5 consecutive days after administration of antiviral therapy, to see the trend of therapy response on viral shedding. Samples for more than 5 days were received from patients till they showed no amplification for any of the three target genes (Influenza A, Swine Influenza A or Swine H1. Results and Conclusion: In 99.33% (149/150 cases, the influenza infection resolved within 10 days. Sixty-four percent (96/150 of the positive patients turned negative within 5 days of the start of antiviral treatment. Only one patient belonging to high risk group showed prolonged virus shedding (19 days.

Gandhoke I

2011-01-01

234

Focus on pandemic 2009 H1N1 influenza (swine flu).  

Science.gov (United States)

At the moment of the onset of the pandemic there were few data about the transmission of the 2009 H1N1 virus infection from the mother to the newborn. Nevertheless neonates born to an ill mother from 2 days before through 7 days after illness onset in the mother were thought to be exposed and potentially infected. In October 2009 the Infectious Disease Group of the Italian Society of Neonatology provided a guide regarded the management of suspected or confirmed maternal infection with 2009 H1N1 influenza virus within labor and delivery, postpartum, and newborn care settings in hospitals. It was based on the available scientific information, according to the U.S. Centers for Disease Control and Prevention (CDC) and the Italian Ministry of Labour, Health and Social Policy recommendations in order to protect the infant from exposure to respiratory secretion during or immediately after delivery. Moreover, we published 300,000 copies of a more popular pamphlet for parents. Rigorous attention to Standard Precautions and Droplet Precautions is required to reduce the opportunities for the transmission of the infection in the health-care setting. PMID:21089717

Lanari, M; Capretti, M G; Decembrino, L; Natale, F; Pedicino, R; Pugni, L; Serra, L

2010-06-01

235

Spatial dynamics of the 1918 influenza pandemic in England, Wales and the United States.  

Science.gov (United States)

There is still limited understanding of key determinants of spatial spread of influenza. The 1918 pandemic provides an opportunity to elucidate spatial determinants of spread on a large scale. To better characterize the spread of the 1918 major wave, we fitted a range of city-to-city transmission models to mortality data collected for 246 population centres in England and Wales and 47 cities in the US. Using a gravity model for city-to-city contacts, we explored the effect of population size and distance on the spread of disease and tested assumptions regarding density dependence in connectivity between cities. We employed Bayesian Markov Chain Monte Carlo methods to estimate parameters of the model for population, infectivity, distance and density dependence. We inferred the most likely transmission trees for both countries. For England and Wales, a model that estimated the degree of density dependence in connectivity between cities was preferable by deviance information criterion comparison. Early in the major wave, long distance infective interactions predominated, with local infection events more likely as the epidemic became widespread. For the US, with fewer more widely dispersed cities, statistical power was lacking to estimate population size dependence or the degree of density dependence, with the preferred model depending on distance only. We find that parameters estimated from the England and Wales dataset can be applied to the US data with no likelihood penalty. PMID:20573630

Eggo, Rosalind M; Cauchemez, Simon; Ferguson, Neil M

2011-02-01

236

Enhancement of collective immunity in Tokyo metropolitan area by selective vaccination against an emerging influenza pandemic.  

Science.gov (United States)

Vaccination is a preventive measure against influenza that does not require placing restrictions on social activities. However, since the stockpile of vaccine that can be prepared before the arrival of an emerging pandemic strain is generally quite limited, one has to select priority target groups to which the first stockpile is distributed. In this paper, we study a simulation-based priority target selection method with the goal of enhancing the collective immunity of the whole population. To model the region in which the disease spreads, we consider an urban area composed of suburbs and central areas connected by a single commuter train line. Human activity is modelled following an agent-based approach. The degree to which collective immunity is enhanced is judged by the attack rate in unvaccinated people. The simulation results show that if students and office workers are given exclusive priority in the first three months, the attack rate can be reduced from [Formula: see text] in the baseline case down to 1-2%. In contrast, random vaccination only slightly reduces the attack rate. It should be noted that giving preference to active social groups does not mean sacrificing those at high risk, which corresponds to the elderly in our simulation model. Compared with the random administration of vaccine to all social groups, this design successfully reduces the attack rate across all age groups. PMID:24058445

Saito, Masaya M; Imoto, Seiya; Yamaguchi, Rui; Tsubokura, Masaharu; Kami, Masahiro; Nakada, Haruka; Sato, Hiroki; Miyano, Satoru; Higuchi, Tomoyuki

2013-01-01

237

Analysis of the effectiveness of interventions used during the 2009 A/H1N1 influenza pandemic  

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Full Text Available Abstract Background Following the emergence of the A/H1N1 2009 influenza pandemic, public health interventions were activated to lessen its potential impact. Computer modelling and simulation can be used to determine the potential effectiveness of the social distancing and antiviral drug therapy interventions that were used at the early stages of the pandemic, providing guidance to public health policy makers as to intervention strategies in future pandemics involving a highly pathogenic influenza strain. Methods An individual-based model of a real community with a population of approximately 30,000 was used to determine the impact of alternative interventions strategies, including those used in the initial stages of the 2009 pandemic. Different interventions, namely school closure and antiviral strategies, were simulated in isolation and in combination to form different plausible scenarios. We simulated epidemics with reproduction numbers R0of 1.5, which aligns with estimates in the range 1.4-1.6 determined from the initial outbreak in Mexico. Results School closure of 1 week was determined to have minimal effect on reducing overall illness attack rate. Antiviral drug treatment of 50% of symptomatic cases reduced the attack rate by 6.5%, from an unmitigated rate of 32.5% to 26%. Treatment of diagnosed individuals combined with additional household prophylaxis reduced the final attack rate to 19%. Further extension of prophylaxis to close contacts (in schools and workplaces further reduced the overall attack rate to 13% and reduced the peak daily illness rate from 120 to 22 per 10,000 individuals. We determined the size of antiviral stockpile required; the ratio of the required number of antiviral courses to population was 13% for the treatment-only strategy, 25% for treatment and household prophylaxis and 40% for treatment, household and extended prophylaxis. Additional simulations suggest that coupling school closure with the antiviral strategies further reduces epidemic impact. Conclusions These results suggest that the aggressive use of antiviral drugs together with extended school closure may substantially slow the rate of influenza epidemic development. These strategies are more rigorous than those actually used during the early stages of the relatively mild 2009 pandemic, and are appropriate for future pandemics that have high morbidity and mortality rates.

Milne George J

2010-03-01

238

A cost comparison of electronic and hybrid data collection systems in Ontario during pandemic and seasonal influenza vaccination campaigns  

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Full Text Available Abstract Background During the pandemic (H1N1 2009 influenza vaccination campaign, health regions in Canada collected client-level immunization data using fully electronic or hybrid systems, with the latter comprising both electronic and paper-based elements. The objective of our evaluation was to compare projected five-year costs associated with implementing these systems in Ontario public health units (PHUs during pandemic and seasonal influenza vaccination campaigns. Methods Six PHUs provided equipment and staffing costs during the pandemic (H1N1 2009 influenza vaccination campaign and staffing algorithms for seasonal campaigns. We standardized resources to population sizes 100,000, 500,000 and 1,000,000, assuming equipment lifetime of five years and public health vaccine administration rates of 18% and 2.5% for H1N1 and seasonal campaigns, respectively. Two scenarios were considered: Year 1 pandemic and Year 1 seasonal campaigns, each followed by four regular influenza seasons. Costs were discounted at 5%. Results Assuming a Year 1 pandemic, the five-year costs per capita for the electronic system decrease as PHU population size increases, becoming increasingly less costly than hybrid systems ($4.33 vs. $4.34 [100,000], $4.17 vs. $4.34 [500,000], $4.12 vs. $4.34 [1,000, 000]. The same trend is observed for the scenario reflecting five seasonal campaigns, with the electronic system being less expensive per capita than the hybrid system for all population sizes ($1.93 vs. $1.95 [100,000], $1.91 vs. $1.94 [500,000], $1.87 vs. $1.94 [1,000, 000]. Sensitivity analyses identified factors related to nurse hours as affecting the direction and magnitude of the results. Conclusions Five-year cost projections for electronic systems were comparable or less expensive than for hybrid systems, at all PHU population sizes. An intangible benefit of the electronic system is having data rapidly available for reporting.

Quan Sherman D

2011-09-01

239

Did the pandemic have an impact on influenza vaccination attitude? a survey among health care workers  

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Full Text Available Abstract Background Health care workers' (HCWs influenza vaccination attitude is known to be negative. The H1N1 epidemic had started in mid 2009 and made a peak in October-November in Turkey. A national vaccination campaign began on November 2nd, 2009. Despite the diligent efforts of the Ministry of Health and NGOs, the attitudes of the media and politicians were mostly negative. The aim of this study was to evaluate whether HCWs' vaccination attitudes improved during the pandemic and to assess the related factors. Methods This cross-sectional survey was carried out at the largest university hospital of the Aegean Region-Turkey. A self-administered questionnaire with 12 structured questions was applied to 807 HCWs (sample coverage 91.3% before the onset of the vaccination programme. Their final vaccination status was tracked one week afterwards, using immunization records. Factors influencing vaccination rates were analyzed using ANOVA, t-test, chi-square test and logistic regression. Results Among 807 participants, 363 (45.3% were doctors and 293 (36.6% nurses. A total of 153 (19.0% had been vaccinated against seasonal influenza in the 2008-2009 season. Regarding H1N1 vaccination, 143 (17.7% were willing to be vaccinated vs. 357 (44.2% unwilling. The number of indecisive HCWs was 307 (38.0% one week prior to vaccination. Only 53 (11.1% stated that they would vaccinate their children. Possible side effects (78%, n = 519 and lack of comprehensive field evaluation before marketing (77%, n = 508 were the most common reasons underlying unwillingness or hesitation. Among the 749 staff whose vaccination status could be tracked, 228 (30.4% actually received the H1N1 vaccine. Some of the 'decided' staff members had changed their mind one week later. Only 82 (60% of those willing, 108 (37% of those indecisive and 38 (12% of those unwilling were vaccinated. Indecisive HCWs were significantly younger (p = 0.017. Females, nurses, and HCWs working in surgical departments were more likely to reject vaccination (p Conclusions Vaccination rates increased substantially in comparison to the previous influenza season. However, vaccination rates could have been even higher since hesitation to be vaccinated increased dramatically within one week (only 60% of those willing and the minority of those indecisive were finally vaccinated. We speculate that this may be connected with negative media at the time.

Pullukçu Hüsnü

2011-04-01

240

Costo-efectividad de la vacunación contra influenza pandémica en mujeres embarazadas en Colombia / Cost-effectiveness of vaccinating pregnant women against pandemic influenza in Colombia  

Scientific Electronic Library Online (English)

Full Text Available SciELO Public Health | Language: Spanish Abstract in spanish OBJETIVO: Estimar la relación costo-efectividad de la vacunación contra influenza pandémica A (H1N1) 2009 en mujeres embarazadas en Colombia durante la segunda onda de la pandemia. MÉTODOS: Se construyó un árbol de decisiones que simulaba los resultados sanitarios (muertes y años potenciales de vida [...] perdidos, APVP) en dos cohortes de mujeres embarazadas, una vacunada y otra sin vacunar. Los parámetros del modelo fueron extraídos de la literatura científica y los costos se estimaron a partir de un estudio previo. Se calcularon razones de costo-efectividad incrementales (RCEI). RESULTADOS: La vacunación de embarazadas contra influenza pandémica habría evitado entre 4 664 y 15 741 consultas ambulatorias y entre 119 y 401 hospitalizaciones. Los costos de atención evitados serían de US$ 249 530 a US$ 842 163. Para el escenario base, vacunar embarazadas sería costo-efectivo (RCEI/APVP evitado US$ 7 657). Esta RCEI fue sensible a la letalidad de la enfermedad; en escenarios de baja letalidad la vacunación no sería costo-efectiva en Colombia. CONCLUSIONES: La vacunación en embarazadas contra influenza pandémica es costo-efectiva en un escenario de alta mortalidad. La evidencia existente de que las mujeres embarazadas tienen mayor riesgo de presentar complicaciones y de que la vacuna es segura justificaría su uso en embarazadas. Abstract in english OBJECTIVE: Estimating the cost-effectiveness ratio of vaccinating pregnant women against the 2009 pandemic influenza A (H1N1) in Colombia during the second wave of the pandemic. METHODS: A decision tree was constructed, which simulated the health results (deaths and years of potential life lost [YPL [...] L]) in two cohorts of pregnant women; one vaccinated, the other unvaccinated. The model's parameters were drawn from scientific literature and costs were estimated on the basis of a previous study. Incremental cost-effectiveness ratios (ICER) were calculated. RESULTS: Vaccinating pregnant women against pandemic flu would have prevented between 4 664 and 15 741 outpatient visits and between 119 and 401 hospitalizations. Between US$ 249 530 and US$ 842 163 in costs of care would have been avoided. For the base scenario, vaccinating pregnant women would be cost-effective (ICER/YPLL avoided US$ 7 657). This ICER was responsive to the disease's fatality rate; vaccina tion would not be cost-effective in Colombia in scenarios with a lower fatality rate. CONCLUSIONS: Vaccinating pregnant women against pandemic influenza is cost-effective in a scenario with a high mortality rate. The existing evidence that pregnant women are at increased risk of complications and that the vaccine is safe would justify its use in pregnant women.

Luz Angela, Chocontá-Piraquive; Nelson, Alvis Guzmán; Fernando, De la Hoz Restrepo.

 
 
 
 
241

Effectiveness of a MF-59™-adjuvanted pandemic influenza vaccine to prevent 2009 A/H1N1 influenza-related hospitalisation; a matched case-control study  

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Full Text Available Abstract Background During the 2009 influenza A/H1N1 pandemic, adjuvanted influenza vaccines were used for the first time on a large scale. Results on the effectiveness of the vaccines in preventing 2009 influenza A/H1N1-related hospitalisation are scanty and varying. Methods We conducted a matched case-control study in individuals with an indication for vaccination due to underlying medical conditions and/or age ? 60 years in the Netherlands. Cases were patients hospitalised with laboratory-confirmed 2009 A/H1N1 influenza infection between November 16, 2009 and January 15, 2010. Controls were matched to cases on age, sex and type of underlying medical condition(s and drawn from an extensive general practitioner network. Conditional logistic regression was used to estimate the vaccine effectiveness (VE = 1 - OR. Different sensitivity analyses were used to assess confounding by severity of underlying medical condition(s and the effect of different assumptions for missing dates of vaccination. Results 149 cases and 28,238 matched controls were included. It was estimated that 22% of the cases and 28% of the controls received vaccination more than 7 days before the date of onset of symptoms in cases. A significant number of breakthrough infections were observed. The VE was estimated at 19% (95%CI -28-49. After restricting the analysis to cases with controls suffering from severe underlying medical conditions, the VE was 49% (95%CI 16-69. Conclusions The number of breakthrough infections, resulting in modest VE estimates, suggests that the MF-59™ adjuvanted vaccine may have had only a limited impact on preventing 2009 influenza A/H1N1-related hospitalisation in this setting. As the main aim of influenza vaccination programmes is to reduce severe influenza-related morbidity and mortality from influenza in persons at high risk of complications, a more effective vaccine, or additional preventive measures, are needed.

van der Sande Marianne AB

2011-07-01

242

Modelling the progression of pandemic influenza A (H1N1 in Vietnam and the opportunities for reassortment with other influenza viruses  

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Full Text Available Abstract Background A novel variant of influenza A (H1N1 is causing a pandemic and, although the illness is usually mild, there are concerns that its virulence could change through reassortment with other influenza viruses. This is of greater concern in parts of Southeast Asia, where the population density is high, influenza is less seasonal, human-animal contact is common and avian influenza is still endemic. Methods We developed an age- and spatially-structured mathematical model in order to estimate the potential impact of pandemic H1N1 in Vietnam and the opportunities for reassortment with animal influenza viruses. The model tracks human infection among domestic animal owners and non-owners and also estimates the numbers of animals may be exposed to infected humans. Results In the absence of effective interventions, the model predicts that the introduction of pandemic H1N1 will result in an epidemic that spreads to half of Vietnam's provinces within 57 days (interquartile range (IQR: 45-86.5 and peaks 81 days after introduction (IQR: 62.5-121 days. For the current published range of the 2009 H1N1 influenza's basic reproductive number (1.2-3.1, we estimate a median of 410,000 cases among swine owners (IQR: 220,000-670,000 with 460,000 exposed swine (IQR: 260,000-740,000, 350,000 cases among chicken owners (IQR: 170,000-630,000 with 3.7 million exposed chickens (IQR: 1.9 M-6.4 M, and 51,000 cases among duck owners (IQR: 24,000 - 96,000, with 1.2 million exposed ducks (IQR: 0.6 M-2.1 M. The median number of overall human infections in Vietnam for this range of the basic reproductive number is 6.4 million (IQR: 4.4 M-8.0 M. Conclusion It is likely that, in the absence of effective interventions, the introduction of a novel H1N1 into a densely populated country such as Vietnam will result in a widespread epidemic. A large epidemic in a country with intense human-animal interaction and continued co-circulation of other seasonal and avian viruses would provide substantial opportunities for H1N1 to acquire new genes.

Farrar Jeremy

2009-09-01

243

Response to the 2009-H1N1 influenza pandemic in the Mekong Basin: surveys of country health leaders  

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Full Text Available Abstract Background Soon after the 2009-H1N1 virus emerged as the first influenza pandemic in 41 years, countries had an early opportunity to test their preparedness plans, protocols and procedures, including their cooperation with other countries in responding to the global pandemic threat. The Mekong Basin Disease Surveillance cooperation (MBDS comprises six countries - Cambodia, China (Yunnan and Guangxi Provinces, Lao People's Democratic Republic, Myanmar, Thailand and Vietnam - that formally organized themselves in 2001 to cooperate in disease surveillance and control. The pandemic presented an opportunity to assess their responses in light of their individual and joint planning. We conducted two surveys of the MBDS leadership from each country, early during the pandemic and shortly after it ended. Results On average, participants rated their country's pandemic response performance as good in both 2009 and 2010. Post-pandemic (2010, perceived performance quality was best for facility-based interventions (overall mean of 4.2 on a scale from 1 = poor to 5 = excellent, followed by surveillance and information sharing (4.1, risk communications (3.9 and disease prevention and control in communities (3.7. Performance was consistently rated as good or excellent for use of hotlines for case reporting (2010 mean of 4.4 and of selected facility-based interventions (each with a 2010 mean of 4.4: using hospital admission criteria, preparing or using isolation areas, using PPE for healthcare workers and using antiviral drugs for treatment. In at least half the countries, the post-pandemic ratings were lower than initial 2009 assessments for performance related to surveillance, facility-based interventions and risk communications. Conclusions MBDS health leaders perceived their pandemic responses effective in areas previously considered problematic. Most felt that MBDS cooperation helped drive and thus added value to their efforts. Surveillance capacity within countries and surveillance information sharing across countries, longstanding MBDS focus areas, were cited as particular strengths. Several areas needing further improvement are already core strategies in the 2011-2016 MBDS Action Plan. Self-organized sub-regional cooperation in disease surveillance is increasingly recognized as an important new element in global disease prevention and control. Our findings suggest that more research is needed to understand the characteristics of networking that will result in the best shared outcomes.

Dausey David J

2011-09-01

244

A polyvalent influenza A DNA vaccine induces heterologous immunity and protects pigs against pandemic A(H1N1)pdm09 virus infection  

DEFF Research Database (Denmark)

The composition of current influenza protein vaccines has to be reconsidered every season to match the circulating influenza viruses, continuously changing antigenicity. Thus, influenza vaccines inducing a broad cross-reactive immune response would be a great advantage for protection against both seasonal and emerging influenza viruses. We have developed an alternative influenza vaccine based on DNA expressing selected influenza proteins of pandemic and seasonal origin. In the current study, we investigated the protection of a polyvalent influenza DNA vaccine approach in pigs. We immunised pigs intradermally with a combination of influenza DNA vaccine components based on the pandemic 1918 H1N1 (M and NP genes), pandemic 2009 H1N1pdm09 (HA and NA genes) and seasonal 2005 H3N2 genes (HA and NA genes) and investigated the protection against infection with virus both homologous and heterologous to the DNA vaccine components. We found that pigs challenged with a virus homologous to the HA and NA DNA vaccine components were well protected from infection. In addition, heterologous challenge virus was cleared rapidly compared to the unvaccinated control pigs. Immunisation by electroporation induced HI antibodies >40 HAU/ml seven days after second vaccination. Heterologous virus challenge as long as ten weeks after last immunisation was able to trigger a vaccine antibody HI response 26 times higher than in the control pigs. The H3N2 DNA vaccine HA and NA genes also triggered an effective vaccine response with protective antibody titres towards heterologous H3N2 virus. The described influenza DNA vaccine is able to induce broadly protective immune responses even in a larger animal, like the pig, against both heterologous and homologous virus challenges despite relatively low HI titres after vaccination. The ability of this DNA vaccine to limit virus shedding may have an impact on virus spread among pigs which could possibly extend to humans as well, thereby diminishing the risk for epidemics and pandemics to evolve.

Bragstad, Karoline; Vinner, Lasse

2013-01-01

245

Influenza in hospitalized children in Ireland in the pandemic period and the 2010/2011 season: risk factors for paediatric intensive-care-unit admission.  

Science.gov (United States)

Influenza causes significant morbidity and mortality in children. This study's objectives were to describe influenza A(H1N1)pdm09 during the pandemic, to compare it with circulating influenza in 2010/2011, and to identify risk factors for severe influenza defined as requiring admission to a paediatric intensive care unit (PICU). Children hospitalized with influenza during the pandemic were older, and more likely to have received antiviral therapy than children hospitalized during the 2010/2011 season. In 2010/2011, only one child admitted to a PICU with underlying medical conditions had been vaccinated. The risk of severe illness in the pandemic was higher in females and those with underlying conditions. In 2010/2011, infection with influenza A(H1N1)pdm09 compared to other influenza viruses was a significant risk factor for severe disease. An incremental relationship was found between the number of underlying conditions and PICU admission. These findings highlight the importance of improving low vaccination uptake and increasing the use of antivirals in vulnerable children. PMID:24229618

Rebolledo, J; Igoe, D; O'Donnell, J; Domegan, L; Boland, M; Freyne, B; McNAMARA, A; Molloy, E; Callaghan, M; Ryan, A; O'Flanagan, D

2014-09-01

246

Mammalian pathogenesis of oseltamivir-resistant pandemic (H1N1) 2009 influenza virus isolated in South Korea.  

Science.gov (United States)

Oseltamivir, a neuraminidase (NA) inhibitor, has been widely used for the treatment of patients infected with the pandemic (H1N1) 2009 influenza virus. With the increasing use of oseltamivir, drug-resistant mutants emerged rapidly and 11 cases of resistant viruses were detected during the 2009 H1N1 pandemic in South Korea. To better understand the differences between oseltamivir-susceptible and oseltamivir-resistant virus, we compared the replication and pathogenesis of the NA H275Y mutant virus, A/Gyeongnam/1820/2009, in ferrets and mice with those of oseltamivir-susceptible A/Korea/01/2009 virus. Oseltamivir-resistant virus infected ferrets showed mild clinical signs and the virus replicated well in the upper respiratory tract and slightly in the lower respiratory tract. No virus was detected in the extrapulmonary organs. Severe bronchopneumonia and thickening of alveolar walls were detected in the lungs. Viral antigens were detected mainly in the bronchiolar epithelial cells, cells present in the interstitial septa, pneumocytes and peribronchial glands with severe peribronchitis. A/Gyeongnam/1820/2009 virus-infected mice showed weight loss and the virus replicated in lungs with high titer. Histopathologically, the mice showed mild to moderate alveolitis, interstitial pneumonia and perivascular lymphoid tissue hyperplasia. In lungs, bronchiolar epithelial cells, pneumocytes and interstitial inflammatory cells were infected by influenza virus and trachea epithelial cells were the sites of infection. When compared with the results of A/Korea/01/2009 oseltamivir-susceptible pandemic influenza virus, an oseltamivir-resistant virus isolated in South Korea showed fewer pathogenic properties in ferrets and similar fitness in mice. PMID:24657788

Kwon, Donghyok; Shin, Kyeongcheol; Kim, Su-Jin; Lee, Joo-Yeon; Kang, Chun

2014-06-24

247

Antigenic and genetic analysis of pandemic influenza A(H1N1) 2009 viruses from Portugal  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Backround: The influenza AH1N1 2009 pandemic virus (AH1N1pdm) was first detected in Portugal in May 4th 2009. This virus had origin in a reassortment between a North American swine lineage (already a triple reassortant, circulating in pigs since the late 1990’s) and a Eurasian swine lineage. As the HA (North American swine lineage) continues to circulate in the human population, its antigenic sites will continue to be targeted by antibody-mediated selection pressure. Therefore it is importa...

Pechirra, Pedro; Arraiolos, Ana; Conde, Patri?cia; Gonc?alves, Paulo; Cordeiro, Rita; Guiomar, Raquel

2010-01-01

248

Enhanced surveillance of initial cases of pandemic H1N1 2009 influenza in Ireland, April-July 2009.  

LENUS (Irish Health Repository)

From 28 April to 18 July 2009 there were 156 cases of pandemic H1N1 2009 influenza confirmed in Ireland. During this time, Ireland was in containment phase, and detailed case-based epidemiological information was gathered on all cases presenting in the community and acute health care setting. Active case finding was performed among contacts of cases. Eighty percent of cases were in people less than 35 years of age and 86% were imported. The most frequent symptoms were fever, sore throat, myalgia and dry cough. Nine people were hospitalized, no fatalities occurred.

Martin, J

2009-09-24

249

In vitro assessment of the allergenicity of novel MF59-adjuvanted pandemic H1N1 influenza vaccine produced in dog kidney cells.  

Science.gov (United States)

A licensed inactivated MF59-adjuvanted seasonal influenza vaccine (Optaflu) produced in canine kidney cells (MDCK 33016-PF) contained no egg proteins and did not trigger degranulation in rat basophilic leukemia (RBL) cells passively sensitized with human anti-dog IgE, supporting its safe use in dog-allergic individuals. The cell-derived pandemic H1N1 influenza vaccine was also adjuvanted with the emulsion adjuvant MF59, and support for its similar safe use was sought. We sought to evaluate in vitro allergenicity of the MF59-adjuvanted cell-derived pandemic H1N1 influenza vaccine in subjects with dog allergy, with a mediator release assay. RBL-2H3 cells transfected with human Fc? receptor type 1 were sensitized with sera from adult dog-allergic subjects and stimulated with serial dilutions of pandemic H1N1 influenza vaccine and dog dander extract. ?-N-hexosaminidase release (NHR) was used as a marker of RBL degranulation.. Median dog dander-specific IgE in 30 dog-allergic subjects was 27.7 kU(A)/L (range 10.1; > 100); and in 5 dog non-allergic subjects was dog-allergic subjects was: pandemic H1N1 influenza vaccine 1.1% (0; 4.4) and dog dander 6.9% (0.7; 37.3), P dog IgE, supporting its safe use in dog-allergic individuals. PMID:22777093

Bencharitiwong, Ramon; Leonard, Stephanie; Tsai, Theodore; Nowak-W?grzyn, Anna

2012-07-01

250

INFLUENZA H5N1: NEXT PANDEMIC? / INFLUENZA H5N1: PANDEMIA PRÓXIMO? / INFLUENZA H5N1: PRÓXIMA PANDEMIA?  

Scientific Electronic Library Online (English)

Full Text Available SciELO Colombia | Language: English Abstract in portuguese Desde 1990 se têm reportado casos de pacientes infectados por influenza causadas por vírus de baixa patogenicidade, porém, desde o ano 1997, vírus altamente patógenos como o A/H5N1 têm provocado um aumento no número de pessoas infectadas por transmissão zoonótica. Os pacientes infectados apresentam [...] sintomas constitucionais e respiratórios, transtornos hematológicos e disfunção hepática. Cerca dametade de casos são pacientes menores de 20 anos, e aproximadamente o 90% são menores de 40 anos. Recentes estudos em mamíferos indicam que são necessárias algumas mutações no genoma viral para que o vírustenha a capacidade de infectar células mamíferas. Em resposta a estes estudos o centro de controle de doenças (por suas siglas em inglês: Centers for Disease Controle), ente regulador na dinâmica epidemiológica mundial propõe continuar com as pesquisassem alertar aos sistemas de saúde, pois em este momento não constituiu maameaça mundial. Porém, este aspecto toma lugar como uma preocupação importante desde o ponto de vista dasaúde pública, já que poderia constituir a próxima pandemia. Devido à alta mortalidade em humanos que se apresenta nos casos de pacientes infectados com este vírus, um surto ou uma pandemia, exigirão por tanto um conhecimento apropriado da biologia do vírus da influenza aviar, os determinantes dasua patogenicidade, a prevenção mediante vacinae os possíveis esquemas de tratamento. Abstract in spanish Desde 1990 se han reportado casos de pacientes infectados por influenza causadas por virus de baja patogenicidad, sin embargo, desde el año 1997, virus altamente patógenos como el A/H5N1 han provocado un aumento en el número de personas infectadas por transmisión zoonotica. Los pacientes infectados [...] presentan síntomas constitucionales y respiratorios, trastornos hematológicos y disfunción hepática. Cerca de la mitad de casos son pacientes menores de 20 años, y aproximadamente el 90% son menores de 40 años. Recientes estudios en mamíferos indican que son necesarias algunas mutaciones en el genoma viral para que el virus tenga la capacidad de infectar células mamíferas. En respuesta a estos estudios el centro de control de enfermedades (por sus siglas en ingles Centers for Disease Control), ente regulador en la dinámica epidemiológica mundial propone continuar con las investigaciones sin alertar a los sistemas de salud, pues en este momento no constituye una amenaza mundial. Sin embargo, este aspecto toma lugar como una preocupación importante desde el punto de vista de la salud pública, por cuanto podría constituir la próxima pandemia. Debido a la alta mortalidad en humanos que se presenta en los casos de pacientes infectados con este virus, un brote o una pandemia exigirán por tanto un conocimiento apropiado de la biología del virus de la influenza aviar, los determinantes de su patogenicidad, la prevención mediante vacuna y los posibles esquemas de tratamiento. Abstract in english Since 1990 there have been cases of patients infected by influenza caused by Low Pathogenic Avian Influenza. However, since 1997, highly pathogenic viruses, such as A/H5N1, have caused an increase in the number of people infected via zoonotic transmission. Infected patients have constitutional and m [...] ainly respiratory symptoms, hematological disorders and liver dysfunction. About half of patients are under 20 years and about 90% under 40 years. In recent studies in mammals it seems that only few mutations in viral genome are necessary to confer the virus the ability to infect mammalian cells. In response to these studies, the Centers for Disease Control (CDC) propose continuous researches without alerting the health care system, because, at present, there is not a global threat. Moreover, in the future, this issue would take place as a major concern from the point of view of public health; it could be the next pandemic. Due to the high human mortality rate occurring in cases o

JEFFERSON, GUERRERO; LINDA, NAVARRETE; DIANA, ROLDÁN; MARÍA PAULA, PEÑA; JEIMY, OVIEDO; IVÁN, MÉNDEZ.

2013-12-01

251

INFLUENZA H5N1: NEXT PANDEMIC? / INFLUENZA H5N1: PANDEMIA PRÓXIMO? / INFLUENZA H5N1: PRÓXIMA PANDEMIA?  

Scientific Electronic Library Online (English)

Full Text Available SciELO Colombia | Language: English Abstract in portuguese Desde 1990 se têm reportado casos de pacientes infectados por influenza causadas por vírus de baixa patogenicidade, porém, desde o ano 1997, vírus altamente patógenos como o A/H5N1 têm provocado um aumento no número de pessoas infectadas por transmissão zoonótica. Os pacientes infectados apresentam [...] sintomas constitucionais e respiratórios, transtornos hematológicos e disfunção hepática. Cerca dametade de casos são pacientes menores de 20 anos, e aproximadamente o 90% são menores de 40 anos. Recentes estudos em mamíferos indicam que são necessárias algumas mutações no genoma viral para que o vírustenha a capacidade de infectar células mamíferas. Em resposta a estes estudos o centro de controle de doenças (por suas siglas em inglês: Centers for Disease Controle), ente regulador na dinâmica epidemiológica mundial propõe continuar com as pesquisassem alertar aos sistemas de saúde, pois em este momento não constituiu maameaça mundial. Porém, este aspecto toma lugar como uma preocupação importante desde o ponto de vista dasaúde pública, já que poderia constituir a próxima pandemia. Devido à alta mortalidade em humanos que se apresenta nos casos de pacientes infectados com este vírus, um surto ou uma pandemia, exigirão por tanto um conhecimento apropriado da biologia do vírus da influenza aviar, os determinantes dasua patogenicidade, a prevenção mediante vacinae os possíveis esquemas de tratamento. Abstract in spanish Desde 1990 se han reportado casos de pacientes infectados por influenza causadas por virus de baja patogenicidad, sin embargo, desde el año 1997, virus altamente patógenos como el A/H5N1 han provocado un aumento en el número de personas infectadas por transmisión zoonotica. Los pacientes infectados [...] presentan síntomas constitucionales y respiratorios, trastornos hematológicos y disfunción hepática. Cerca de la mitad de casos son pacientes menores de 20 años, y aproximadamente el 90% son menores de 40 años. Recientes estudios en mamíferos indican que son necesarias algunas mutaciones en el genoma viral para que el virus tenga la capacidad de infectar células mamíferas. En respuesta a estos estudios el centro de control de enfermedades (por sus siglas en ingles Centers for Disease Control), ente regulador en la dinámica epidemiológica mundial propone continuar con las investigaciones sin alertar a los sistemas de salud, pues en este momento no constituye una amenaza mundial. Sin embargo, este aspecto toma lugar como una preocupación importante desde el punto de vista de la salud pública, por cuanto podría constituir la próxima pandemia. Debido a la alta mortalidad en humanos que se presenta en los casos de pacientes infectados con este virus, un brote o una pandemia exigirán por tanto un conocimiento apropiado de la biología del virus de la influenza aviar, los determinantes de su patogenicidad, la prevención mediante vacuna y los posibles esquemas de tratamiento. Abstract in english Since 1990 there have been cases of patients infected by influenza caused by Low Pathogenic Avian Influenza. However, since 1997, highly pathogenic viruses, such as A/H5N1, have caused an increase in the number of people infected via zoonotic transmission. Infected patients have constitutional and m [...] ainly respiratory symptoms, hematological disorders and liver dysfunction. About half of patients are under 20 years and about 90% under 40 years. In recent studies in mammals it seems that only few mutations in viral genome are necessary to confer the virus the ability to infect mammalian cells. In response to these studies, the Centers for Disease Control (CDC) propose continuous researches without alerting the health care system, because, at present, there is not a global threat. Moreover, in the future, this issue would take place as a major concern from the point of view of public health; it could be the next pandemic. Due to the high human mortality rate occurring in cases o

JEFFERSON, GUERRERO; LINDA, NAVARRETE; DIANA, ROLDÁN; MARÍA PAULA, PEÑA; JEIMY, OVIEDO; IVÁN, MÉNDEZ.

252

Impact of the 2009 influenza A(H1N1) pandemic wave on the pattern of hibernal respiratory virus epidemics, France, 2009.  

Science.gov (United States)

This short report based on clinical surveillance and laboratory data describes the circulation of rhinoviruses, influenza viruses and respiratory syncytial viruses (RSV) in France during the 2009-10 season compared with the previous winter season. The delayed circulation of RSV observed in 2009-10 compared with 2008-09 suggests that the early circulation of the 2009 pandemic influenza A(H1N1) viruses had an impact on the RSV epidemic. PMID:20158981

Casalegno, J S; Ottmann, M; Bouscambert-Duchamp, M; Valette, M; Morfin, F; Lina, B

2010-02-11

253

Pandemic influenza A (H1N1) 2009: epidemiological analysis of cases in a tropical/semi-arid region of Brazil  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in english Introduction The year 2009 marked the beginning of a pandemic caused by a new variant of influenza A (H1N1). After spreading through North America, the pandemic influenza virus (H1N1) 2009 spread rapidly throughout the world. The aim of this study was to describe the clinical and epidemio [...] logical characteristics of cases of pandemic influenza in a tropical/semi-arid region of Brazil. Methods A retrospective study analyzed all suspected cases of pandemic influenza (H1N1) 2009 reported in the Ceará State through the National Information System for Notifiable Diseases during the pandemic period between 28 April, 2009 and November 25, 2010. Results A total of 616 suspected cases were notified, 58 (9.4%) in the containment phase and 558 (90.6%) in the mitigation phase. Most cases were of affected young people resident in the City of Fortaleza, the largest urban center in the State of Ceará. The most frequent symptoms presented by the cases with confirmed infection were fever, cough, myalgia, arthralgia, and nasal congestion. Mortality rate was 0.0009/1,000 inhabitants and lethality was 5.6%. Deaths were observed only in the mitigation phase. Mortality rates were similar for both sexes but were higher in the age group under 5 years. Conclusions The study suggests that the influenza A (H1N1) pandemic in this tropical/semi-arid region had a lower magnitude when compared to states in the Southern and Southeastern regions of Brazil.

Roberto da Justa, Pires Neto; Daniele Rocha Queiroz, Lemos; Luciano Pamplona de Góes, Cavalcanti; Alberto Novaes, Ramos Junior; Carlos Henrique, Alencar; Mônica Cardoso, Façanha; Madalena Isabel Coelho, Barroso; Dina Cortez Lima Feitosa, Vilar; Manoel Dias da, Fonseca Neto.

2013-04-01

254

Pandemic influenza A (H1N1) 2009: epidemiological analysis of cases in a tropical/semi-arid region of Brazil  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in english Introduction The year 2009 marked the beginning of a pandemic caused by a new variant of influenza A (H1N1). After spreading through North America, the pandemic influenza virus (H1N1) 2009 spread rapidly throughout the world. The aim of this study was to describe the clinical and epidemio [...] logical characteristics of cases of pandemic influenza in a tropical/semi-arid region of Brazil. Methods A retrospective study analyzed all suspected cases of pandemic influenza (H1N1) 2009 reported in the Ceará State through the National Information System for Notifiable Diseases during the pandemic period between 28 April, 2009 and November 25, 2010. Results A total of 616 suspected cases were notified, 58 (9.4%) in the containment phase and 558 (90.6%) in the mitigation phase. Most cases were of affected young people resident in the City of Fortaleza, the largest urban center in the State of Ceará. The most frequent symptoms presented by the cases with confirmed infection were fever, cough, myalgia, arthralgia, and nasal congestion. Mortality rate was 0.0009/1,000 inhabitants and lethality was 5.6%. Deaths were observed only in the mitigation phase. Mortality rates were similar for both sexes but were higher in the age group under 5 years. Conclusions The study suggests that the influenza A (H1N1) pandemic in this tropical/semi-arid region had a lower magnitude when compared to states in the Southern and Southeastern regions of Brazil.

Roberto da Justa, Pires Neto; Daniele Rocha Queiroz, Lemos; Luciano Pamplona de Góes, Cavalcanti; Alberto Novaes, Ramos Junior; Carlos Henrique, Alencar; Mônica Cardoso, Façanha; Madalena Isabel Coelho, Barroso; Dina Cortez Lima Feitosa, Vilar; Manoel Dias da, Fonseca Neto.

255

Structure, Receptor Binding, and Antigenicity of Influenza Virus Hemagglutinins from the 1957 H2N2 Pandemic  

Energy Technology Data Exchange (ETDEWEB)

The hemagglutinin (HA) envelope protein of influenza viruses mediates essential viral functions, including receptor binding and membrane fusion, and is the major viral antigen for antibody neutralization. The 1957 H2N2 subtype (Asian flu) was one of the three great influenza pandemics of the last century and caused 1 million deaths globally from 1957 to 1968. Three crystal structures of 1957 H2 HAs have been determined at 1.60 to 1.75 {angstrom} resolutions to investigate the structural basis for their antigenicity and evolution from avian to human binding specificity that contributed to its introduction into the human population. These structures, which represent the highest resolutions yet recorded for a complete ectodomain of a glycosylated viral surface antigen, along with the results of glycan microarray binding analysis, suggest that a hydrophobicity switch at residue 226 and elongation of receptor-binding sites were both critical for avian H2 HA to acquire human receptor specificity. H2 influenza viruses continue to circulate in birds and pigs and, therefore, remain a substantial threat for transmission to humans. The H2 HA structure also reveals a highly conserved epitope that could be harnessed in the design of a broader and more universal influenza A virus vaccine.

Xu, Rui; McBride, Ryan; Paulson, James C.; Basler, Christopher F.; Wilson, Ian A. (Sinai); (Scripps)

2010-03-04

256

Pandemic influenza A viruses escape from restriction by human MxA through adaptive mutations in the nucleoprotein.  

Science.gov (United States)

The interferon-induced dynamin-like MxA GTPase restricts the replication of influenza A viruses. We identified adaptive mutations in the nucleoprotein (NP) of pandemic strains A/Brevig Mission/1/1918 (1918) and A/Hamburg/4/2009 (pH1N1) that confer MxA resistance. These resistance-associated amino acids in NP differ between the two strains but form a similar discrete surface-exposed cluster in the body domain of NP, indicating that MxA resistance evolved independently. The 1918 cluster was conserved in all descendent strains of seasonal influenza viruses. Introduction of this cluster into the NP of the MxA-sensitive influenza virus A/Thailand/1(KAN-1)/04 (H5N1) resulted in a gain of MxA resistance coupled with a decrease in viral replication fitness. Conversely, introduction of MxA-sensitive amino acids into pH1N1 NP enhanced viral growth in Mx-negative cells. We conclude that human MxA represents a barrier against zoonotic introduction of avian influenza viruses and that adaptive mutations in the viral NP should be carefully monitored. PMID:23555271

Mänz, Benjamin; Dornfeld, Dominik; Götz, Veronika; Zell, Roland; Zimmermann, Petra; Haller, Otto; Kochs, Georg; Schwemmle, Martin

2013-03-01

257

Safety and immunogenicity of Sinovac's prototype pandemic influenza H5N1 vaccines: a review on clinical trials.  

Science.gov (United States)

Sinovac Biotech started to develop prototype pandemic influenza H5N1 vaccines in March 2004. On 2 April 2008, Sinovac's inactivated, aluminium-adjuvanted, whole-virion prototype pandemic influenza A (H5N1) vaccine (PanFlu) was granted production licensure by the China regulatory authority State Food and Drug Administration. The whole-virion H5N1 vaccine was manufactured in embryonated hens' eggs using the reassortant strain NIBRG-14 (A/Vietnam/1194/2004-A/PR/8/34) as vaccine virus. It showed good safety, immunogenicity and cross-reactivity in immunologically naïve adults. In primed adults, the vaccine induced a strong booster response. Plasma from a vaccinated individual showed a beneficial effect following passive immunotherapy of an H5N1 human infection case. This article reviews the process, status and results of clinical evaluation of Sinovac's whole- and split-virion H5N1 vaccines by focusing on the whole-virion vaccine. PMID:19453400

Qiu, Yuan-Zheng; Yin, Wei-Dong

2008-11-01

258

Systems approaches to influenza-virus host interactions and the pathogenesis of highly virulent and pandemic viruses.  

Science.gov (United States)

Influenza virus research has recently undergone a shift from a virus-centric perspective to one that embraces the full spectrum of virus-host interactions and cellular signaling events that determine disease outcome. This change has been brought about by the increasing use and expanding scope of high-throughput molecular profiling and computational biology, which together fuel discovery in systems biology. In this review, we show how these approaches have revealed an uncontrolled inflammatory response as a contributor to the extreme virulence of the 1918 pandemic and avian H5N1 viruses, and how this response differs from that induced by the 2009 H1N1 viruses responsible for the most recent influenza pandemic. We also discuss how new animal models, such as the Collaborative Cross mouse systems genetics platform, are key to the necessary systematic investigation of the impact of host genetics on infection outcome, how genome-wide RNAi screens have identified hundreds of cellular factors involved in viral replication, and how systems biology approaches are making possible the rational design of new drugs and vaccines against an ever-evolving respiratory virus. PMID:23218769

Korth, Marcus J; Tchitchek, Nicolas; Benecke, Arndt G; Katze, Michael G

2013-10-31

259

A social-cognitive model of pandemic influenza H1N1 risk perception and recommended behaviors in Italy.  

Science.gov (United States)

The outbreak of the pandemic influenza H1N1 2009 (swine flu) between March and April 2009 challenged the health services around the world. Indeed, misconceptions and worries have led the public to refuse to comply with precautionary measures. Moreover, there have been limited efforts to develop models incorporating cognitive, social-contextual, and affective factors as predictors of compliance with recommended behaviors. The aim of this study was to apply a social-cognitive model of risk perception and individual response to pandemic influenza H1N1 in a representative sample of Italian population. A sample of 1,010 Italians of at least 18 years of age took part in a telephone survey. The survey included measures of perceived preparedness of institutions, family members and friends' levels of worry, exposure to media campaigns (social-contextual factors), perceived coping efficacy, likelihood of infection, perceived seriousness, personal impact, and severity of illness (cognitive evaluations), affective response and compliance with recommended behaviors. Results demonstrated that affective response fully mediated the relationship between cognitive evaluations and social-contextual factors (with the exception of exposure to media campaigns) and compliance with recommended behaviors. Perceived coping efficacy and preparedness of institutions were not related to compliance with recommended behaviors. PMID:21077927

Prati, Gabriele; Pietrantoni, Luca; Zani, Bruna

2011-04-01

260

Infection control measures on ships and in ports during the early stage of pandemic influenza A (H1N1) 2009.  

Science.gov (United States)

Shipping companies were surveyed to evaluate the effect of public health measures during the influenza A (H1N1) pandemic of 2009 on ship and port operations. Of 31 companies that operated 960 cruise, cargo, and other ships, 32% experienced health-screening measures by port health authorities. Approximately a quarter of ports (26%) performed screening at embarkation and 77% of shipping companies changed procedures during the early stage of the pandemic. Four companies reported outbreaks of pandemic influenza A (H1N1) 2009 on ships, which were ultimately stopped through infection control practices. Public health measures did not interfere substantially with port and ship operations with the exception of some port authorities that delayed embarking and disembarking procedures in a few ships. However, in the shipping companies' experience, measures were inconsistent between port health authorities. Access to antiviral drugs and pandemic vaccine was not provided in all ports. Current guidelines on medical care, hygiene, and emergency procedures on ships need to address pandemic influenza preparedness in future revisions. PMID:22669808

Schlaich, Clara; Gau, Bettina; Cohen, Nicole J; Kojima, Kazunobu; Marano, Nina; Menucci, Daniel

2012-01-01

 
 
 
 
261

Factors associated with severe illness in pandemic 2009 influenza a (H1N1) infection: implications for triage in primary and secondary care.  

Science.gov (United States)

Pandemic (H1N1) 2009 influenza virus (pH1N1/09) infection spread rapidly around the globe, leading to a phase 6 pandemic level of alert declared in June 2009. The WHO declared the end of the pandemic in August 2010. Although for the majority of infected patients, it manifest as a mild, self-limiting illness, a proportion appeared to follow an adverse clinical course, requiring higher level care and aggressive management strategies. Experience with previous pandemics suggests that H1N1 will continue to circulate for many years. The aim of this review is to evaluate data from published case series reporting patients with pH1N1/09 influenza to identify clinical markers of severe disease. Comorbid illnesses including chronic lung disease, obesity and pregnancy have been shown to confer increased risk of severe infection. Admission vital signs, laboratory investigations and chest radiographic features can guide admitting clinicians to stratify patients' risk of severe disease, however, the currently available severity scoring tools have only a limited role in risk assessment. Knowledge of high risk parameters remains important for clinicians triaging patients with suspected pH1N1/09 influenza and to inform strategies for future pandemics. PMID:21839111

Singanayagam, Anika; Singanayagam, Aran; Wood, Victoria; Chalmers, James D

2011-10-01

262

Prioritization strategies for pandemic influenza vaccine in 27 countries of the European Union and the Global Health Security Action Group: a review  

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Full Text Available Abstract Background Although there is rapid progress in vaccine research regarding influenza pandemic vaccines it is expected that pandemic influenza vaccine production can only start once the pandemic virus has been recognized. Therefore, pandemic vaccine capacity will be limited at least during the first phase of an influenza pandemic, requiring vaccine prioritization strategies. WHO recommends developing preliminary priorities for pandemic vaccine use. The goal of this review is to provide a thorough overview of pandemic vaccine prioritization concepts in the 27 European Union (EU member states and the four non-EU countries of the Global Health Security Action Group. Methods Between September and December 2006 data was collected for each country through two data sources: (i the national influenza pandemic plan; (ii contacting key persons involved in pandemic planning by email and/or phone and/or fax Results Twenty-six (84% countries had established at least one vaccine priority group. Most common reported vaccine priority groups were health care workers (HCW (100%, essential service providers (ESP (92% and high risk individuals (HRI (92%. Ranking of at least one vaccine priority group was done by 17 (65% of 26 countries. Fifteen (88% of these 17 countries including a ranking strategy, decided that HCW with close contact to influenza patients should be vaccinated first; in most countries followed and/or ranked equally by ESP and subsequently HRI. Rationales for prioritization were provided by 22 (85% of 26 countries that established vaccine priority groups. There was large variation in the phrasing and level of detailed specification of rationales. Seven (32% of 22 countries providing rationales clearly associated each vaccine priority group with the specific rationale. Ten (32% of the 31 countries studied countries have consulted and involved ethical experts to guide decisions related to vaccine prioritization. Conclusion In the majority of the countries the establishment of vaccine priority groups, ranking and underlying rationales are in line with WHO recommendations. In most public plans the criteria by which prioritized groups are identified are not easily recognizable. Clarity however, may be necessary to assure public acceptability of the prioritization. Ethical experts, results of modelling exercises could play an increasing role in the future decision making process.

Haas Walter

2007-09-01

263

[Study of Ingavirin antiviral activity against Mexican pandemic influenza virus A/H1N1/2009 in vitro and in vivo].  

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High in vitro and in vivo efficacy of Ingavirin against the Mexican pandemic influenza virus A/H1N1/2009, strains A/California/04/2009 (H1N1) and A/California/07/2009 (H1N1) vs. the reference drug Arbidol was studied and verified when used therapeutically and prophylactically. PMID:21574420

Loginova, S Ya; Borisevich, S V; Shchukina, V N; Lykov, M V; Borisevich, G V; Bondarev, V P; Nebolsin, V E; Sutochnikova, O A; Chychalin, A G

2010-01-01

264

5'PPP-RNA induced RIG-I activation inhibits drug-resistant avian H5N1 as well as 1918 and 2009 pandemic influenza virus replication  

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Full Text Available Abstract Background Emergence of drug-resistant strains of influenza viruses, including avian H5N1 with pandemic potential, 1918 and 2009 A/H1N1 pandemic viruses to currently used antiviral agents, neuraminidase inhibitors and M2 Ion channel blockers, underscores the importance of developing novel antiviral strategies. Activation of innate immune pathogen sensor Retinoic Acid Inducible Gene-I (RIG-I has recently been shown to induce antiviral state. Results In the present investigation, using real time RT-PCR, immunofluorescence, immunoblot, and plaque assay we show that 5'PPP-containing single stranded RNA (5'PPP-RNA, a ligand for the intracytoplasmic RNA sensor, RIG-I can be used as a prophylactic agent against known drug-resistant avian H5N1 and pandemic influenza viruses. 5'PPP-RNA treatment of human lung epithelial cells inhibited replication of drug-resistant avian H5N1 as well as 1918 and 2009 pandemic influenza viruses in a RIG-I and type 1 interferon dependant manner. Additionally, 5'PPP-RNA treatment also inhibited 2009 H1N1 viral replication in vivo in mice. Conclusions Our findings suggest that 5'PPP-RNA mediated activation of RIG-I can suppress replication of influenza viruses irrespective of their genetic make-up, pathogenicity, and drug-sensitivity status.

García-Sastre Adolfo

2010-05-01

265

Complete Genome Sequences of H3N2 Canine Influenza Virus with the Matrix Gene from the Pandemic A/H1N1 Virus.  

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We analyzed the complete genome sequence containing the 3' and 5' noncoding regions (NCRs) of H3N2 canine influenza virus (CIV) with the matrix gene from the pandemic A/H1N1 virus, which will provide a better understanding of the pathogenesis, transmission, and evolution of variant CIV. PMID:25278543

Hong, Minki; Na, Woonsung; Yeom, Minju; Park, Nanuri; Moon, Hyoungjoon; Kang, Bo-Kyu; Kim, Jeong-Ki; Song, Daesub

2014-01-01

266

A monoclonal antibody-based immunoassay for measuring the potency of 2009 pandemic influenza H1N1 vaccines  

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Background The potency of inactivated influenza vaccines is determined using a single radial immunodiffusion (SRID) assay. This assay is relatively easy to standardize, it is not technically demanding, and it is capable of measuring the potency of several vaccine strain subtypes in a multivalent vaccine. Nevertheless, alternative methods that retain the major advantages of the SRID, but with a greater dynamic range of measurement and with reduced reagent requirements, are needed. Objectives The feasibility of an ELISA-based assay format was explored as an alternative potency assay for inactivated influenza vaccines. Methods Several murine monoclonal antibodies (mAbs), specific for the 2009 pandemic H1N1 influenza virus hemagglutinin (HA), were evaluated for their potential to capture and quantify HA antigen. Vaccine samples, obtained from four licensed influenza vaccine manufacturers, included monovalent bulk vaccine, monovalent vaccine, and trivalent vaccine. Traditional SRID potency assays were run in parallel with the mAb–ELISA potency assay using the reference antigen standard appropriate for the vaccine samples being tested. Results The results indicated that the ELISA potency assay can quantify HA over a wide range of concentrations, including vaccine at subpotent doses, and the ELISA and SRID potency values correlated well for most vaccine samples. Importantly, the assay was capable of quantifying A/California HA in a trivalent formulation. Conclusions This study demonstrates the general feasibility of the mAb approach and strongly suggests that such ELISAs have potential for continued development as an alternative method to assay the potency of inactivated influenza vaccines. PMID:25087462

Schmeisser, Falko; Vasudevan, Anupama; Soto, Jackeline; Kumar, Arunima; Williams, Ollie; Weir, Jerry P

2014-01-01

267

Influenza pandemic (H1N1 2009 activity during summer 2009: Effectiveness of the 2008-9 trivalent vaccine against pandemic influenza in Spain Actividad de la gripe pandémica (H1N1 2009 durante el verano de 2009: Efectividad de la vacuna trivalente 2008-9 frente a la gripe pandémica en España  

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Full Text Available Introduction: The Spanish influenza surveillance system (SISS maintained its activity during the summer of 2009 to monitor the influenza pandemic. Objectives: To describe pandemic influenza activity from May to September 2009 and to estimate the effectiveness of the 2008-9 seasonal influenza vaccine against laboratory-confirmed pandemic (H1N1 2009 influenza. Methods: Data from the SISS were used to identify the trend of pandemic (H1N1 2009 influenza outside the influenza season. For the effectiveness study, we compared the vaccination status of notified cases [influenza-like illnesses (ILI laboratory confirmed as pandemic influenza] with that of the test-negative controls. Results: The first laboratory-confirmed case of the pandemic virus was notified in the system in week 20/2009. The ILI rate increased gradually in the study period, exceeding basic activity in week 38. The proportion of pandemic (H1N1 2009 influenza viruses detected by the system represented 14% in week 20/2009 and rapidly increased to 90% in week 34. The adjusted vaccine effectiveness of the 2008-9 seasonal vaccine against laboratory-confirmed pandemic influenza was 12% (-30; 41. Conclusions: The SISS became an essential tool for pandemic monitoring in Spain. The improved SISS will provide more accurate information on influenza activity in future seasonal or pandemic waves. Using surveillance data, we could not demonstrate the effectiveness of the seasonal 2008-9 vaccine against laboratory-confirmed pandemic influenza.Introducción: El Sistema de Vigilancia de Gripe en España (SVGE continuó y reforzó su actividad durante el verano de 2009 con el objetivo de vigilar la evolución de la pandemia en España. Objetivos: Describir la actividad de la gripe pandémica en España de mayo a septiembre de 2009 y estimar la efectividad de la vacuna antigripal estacional 2008-2009 frente a casos confirmados de gripe pandémica (H1N1 2009. Métodos: Se utilizaron datos del SVGE para presentar la evolución de la pandemia por virus (H1N1 2009 fuera de la temporada de vigilancia 2008-2009. Para el estudio de la efectividad vacunal se comparó el estado vacunal de los casos de gripe pandémica confirmados por laboratorio con el de los casos negativos para el virus de la gripe (controles negativos. Resultados: El primer caso confirmado de virus pandémico se notificó en la semana 20/2009. La incidencia de gripe aumentó paulatinamente durante el periodo estudiado y sobrepasó el umbral basal en la semana 38/2009. La proporción de virus (H1N1 2009 detectada por el SVGE fue del 14% en la semana 20 y aumentó rápidamente, llegando a alcanzar el 90% en la semana 34. La efectividad ajustada de la vacuna antigripal 2008-2009 frente a casos confirmados de gripe pandémica fue del 12% (-30; 41. Conclusiones: El SVGE se adaptó y mejoró de forma rápida a las exigencias nacionales e internacionales de vigilancia de la pandemia. Esta mejora supone información más precisa y de calidad en futuras ondas epidémicas/pandémicas. Con los datos obtenidos en vigilancia no se pudo demostrar alguna efectividad de la vacuna antigripal 2008-2009 frente a los casos de gripe pandémica confirmados por laboratorio.

Amparo Larrauri

2011-02-01

268

Influenza pandemic (H1N1) 2009 activity during summer 2009: Effectiveness of the 2008-9 trivalent vaccine against pandemic influenza in Spain / Actividad de la gripe pandémica (H1N1) 2009 durante el verano de 2009: Efectividad de la vacuna trivalente 2008-9 frente a la gripe pandémica en España  

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Full Text Available SciELO Public Health | Language: English Abstract in spanish Introducción: El Sistema de Vigilancia de Gripe en España (SVGE) continuó y reforzó su actividad durante el verano de 2009 con el objetivo de vigilar la evolución de la pandemia en España. Objetivos: Describir la actividad de la gripe pandémica en España de mayo a septiembre de 2009 y estimar la efe [...] ctividad de la vacuna antigripal estacional 2008-2009 frente a casos confirmados de gripe pandémica (H1N1) 2009. Métodos: Se utilizaron datos del SVGE para presentar la evolución de la pandemia por virus (H1N1) 2009 fuera de la temporada de vigilancia 2008-2009. Para el estudio de la efectividad vacunal se comparó el estado vacunal de los casos de gripe pandémica confirmados por laboratorio con el de los casos negativos para el virus de la gripe (controles negativos). Resultados: El primer caso confirmado de virus pandémico se notificó en la semana 20/2009. La incidencia de gripe aumentó paulatinamente durante el periodo estudiado y sobrepasó el umbral basal en la semana 38/2009. La proporción de virus (H1N1) 2009 detectada por el SVGE fue del 14% en la semana 20 y aumentó rápidamente, llegando a alcanzar el 90% en la semana 34. La efectividad ajustada de la vacuna antigripal 2008-2009 frente a casos confirmados de gripe pandémica fue del 12% (-30; 41). Conclusiones: El SVGE se adaptó y mejoró de forma rápida a las exigencias nacionales e internacionales de vigilancia de la pandemia. Esta mejora supone información más precisa y de calidad en futuras ondas epidémicas/pandémicas. Con los datos obtenidos en vigilancia no se pudo demostrar alguna efectividad de la vacuna antigripal 2008-2009 frente a los casos de gripe pandémica confirmados por laboratorio. Abstract in english Introduction: The Spanish influenza surveillance system (SISS) maintained its activity during the summer of 2009 to monitor the influenza pandemic. Objectives: To describe pandemic influenza activity from May to September 2009 and to estimate the effectiveness of the 2008-9 seasonal influenza vaccin [...] e against laboratory-confirmed pandemic (H1N1) 2009 influenza. Methods: Data from the SISS were used to identify the trend of pandemic (H1N1) 2009 influenza outside the influenza season. For the effectiveness study, we compared the vaccination status of notified cases [influenza-like illnesses (ILI) laboratory confirmed as pandemic influenza] with that of the test-negative controls. Results: The first laboratory-confirmed case of the pandemic virus was notified in the system in week 20/2009. The ILI rate increased gradually in the study period, exceeding basic activity in week 38. The proportion of pandemic (H1N1) 2009 influenza viruses detected by the system represented 14% in week 20/2009 and rapidly increased to 90% in week 34. The adjusted vaccine effectiveness of the 2008-9 seasonal vaccine against laboratory-confirmed pandemic influenza was 12% (-30; 41). Conclusions: The SISS became an essential tool for pandemic monitoring in Spain. The improved SISS will provide more accurate information on influenza activity in future seasonal or pandemic waves. Using surveillance data, we could not demonstrate the effectiveness of the seasonal 2008-9 vaccine against laboratory-confirmed pandemic influenza.

Amparo, Larrauri; Camelia, Savulescu; Silvia, Jiménez-Jorge; Pilar, Pérez-Breña; Francisco, Pozo; Inmaculada, Casas; Juan, Ledesma; Salvador de, Mateo.

269

Influenza pandemic (H1N1) 2009 activity during summer 2009: Effectiveness of the 2008-9 trivalent vaccine against pandemic influenza in Spain / Actividad de la gripe pandémica (H1N1) 2009 durante el verano de 2009: Efectividad de la vacuna trivalente 2008-9 frente a la gripe pandémica en España  

Scientific Electronic Library Online (English)

Full Text Available SciELO Spain | Language: English Abstract in spanish Introducción: El Sistema de Vigilancia de Gripe en España (SVGE) continuó y reforzó su actividad durante el verano de 2009 con el objetivo de vigilar la evolución de la pandemia en España. Objetivos: Describir la actividad de la gripe pandémica en España de mayo a septiembre de 2009 y estimar la efe [...] ctividad de la vacuna antigripal estacional 2008-2009 frente a casos confirmados de gripe pandémica (H1N1) 2009. Métodos: Se utilizaron datos del SVGE para presentar la evolución de la pandemia por virus (H1N1) 2009 fuera de la temporada de vigilancia 2008-2009. Para el estudio de la efectividad vacunal se comparó el estado vacunal de los casos de gripe pandémica confirmados por laboratorio con el de los casos negativos para el virus de la gripe (controles negativos). Resultados: El primer caso confirmado de virus pandémico se notificó en la semana 20/2009. La incidencia de gripe aumentó paulatinamente durante el periodo estudiado y sobrepasó el umbral basal en la semana 38/2009. La proporción de virus (H1N1) 2009 detectada por el SVGE fue del 14% en la semana 20 y aumentó rápidamente, llegando a alcanzar el 90% en la semana 34. La efectividad ajustada de la vacuna antigripal 2008-2009 frente a casos confirmados de gripe pandémica fue del 12% (-30; 41). Conclusiones: El SVGE se adaptó y mejoró de forma rápida a las exigencias nacionales e internacionales de vigilancia de la pandemia. Esta mejora supone información más precisa y de calidad en futuras ondas epidémicas/pandémicas. Con los datos obtenidos en vigilancia no se pudo demostrar alguna efectividad de la vacuna antigripal 2008-2009 frente a los casos de gripe pandémica confirmados por laboratorio. Abstract in english Introduction: The Spanish influenza surveillance system (SISS) maintained its activity during the summer of 2009 to monitor the influenza pandemic. Objectives: To describe pandemic influenza activity from May to September 2009 and to estimate the effectiveness of the 2008-9 seasonal influenza vaccin [...] e against laboratory-confirmed pandemic (H1N1) 2009 influenza. Methods: Data from the SISS were used to identify the trend of pandemic (H1N1) 2009 influenza outside the influenza season. For the effectiveness study, we compared the vaccination status of notified cases [influenza-like illnesses (ILI) laboratory confirmed as pandemic influenza] with that of the test-negative controls. Results: The first laboratory-confirmed case of the pandemic virus was notified in the system in week 20/2009. The ILI rate increased gradually in the study period, exceeding basic activity in week 38. The proportion of pandemic (H1N1) 2009 influenza viruses detected by the system represented 14% in week 20/2009 and rapidly increased to 90% in week 34. The adjusted vaccine effectiveness of the 2008-9 seasonal vaccine against laboratory-confirmed pandemic influenza was 12% (-30; 41). Conclusions: The SISS became an essential tool for pandemic monitoring in Spain. The improved SISS will provide more accurate information on influenza activity in future seasonal or pandemic waves. Using surveillance data, we could not demonstrate the effectiveness of the seasonal 2008-9 vaccine against laboratory-confirmed pandemic influenza.

Amparo, Larrauri; Camelia, Savulescu; Silvia, Jiménez-Jorge; Pilar, Pérez-Breña; Francisco, Pozo; Inmaculada, Casas; Juan, Ledesma; Salvador de, Mateo.

270

Clinical characteristics of 2009 pandemic influenza A (H1N1) infection in children and the performance of rapid antigen test  

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Purpose In autumn 2009, the swine-origin influenza A (H1N1) virus spread throughout South Korea. The aims of this study were to determine the clinical characteristics of children infected by the 2009 H1N1 influenza A virus, and to compare the rapid antigen and real-time polymerase chain reaction (PCR) tests. Methods We conducted a retrospective review of patients ?18 years of age who presented to Soonchunhyang University Hospital in Seoul with respiratory symptoms, including fever, between September 2009 and January 2010. A real-time PCR test was used to definitively diagnose 2009 H1N1 influenza A infection. Medical records of confirmed cases were reviewed for sex, age, and the time of infection. The decision to perform rapid antigen testing was not influenced by clinical conditions, but by individual factors such as economic conditions. Its sensitivity and specificity were evaluated compared to real-time PCR test results. Results In total, 934 patients tested positive for H1N1 by real-time PCR. The highest number of patients (48.9%) was diagnosed in November. Most patients (48.2%) were aged between 6 and 10 years. Compared with the H1N1 real-time PCR test results, the rapid antigen test showed 22% sensitivity and 83% specificity. Seventy-eight patients were hospitalized for H1N1 influenza A virus infection, and fever was the most common symptom (97.4%). Conclusion For diagnosis of 2009 H1N1 influenza A virus infection, the rapid antigen test was inferior to the real-time PCR test in both sensitivity and specificity. This outcome suggests that the rapid antigen test is inappropriate for screening. PMID:22232622

Park, Yong-Jae; Jin, Jang-Yong; Yang, Hyeon-Jong; Lee, Woo-Ryung; Lee, Dong-Hwan; Pyun, Bok-Yang

2011-01-01

271

Clinical characteristics of 2009 pandemic influenza A (H1N1 infection in children and the performance of rapid antigen test  

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Full Text Available Purpose : In autumn 2009, the swine-origin influenza A (H1N1 virus spread throughout South Korea. The aims of this study were to determine the clinical characteristics of children infected by the 2009 H1N1 influenza A virus, and to compare the rapid antigen and realtime polymerase chain reaction (PCR tests. Methods : We conducted a retrospective review of patients ?#241;8 years of age who presented to Soonchunhyang University Hospital in Seoul with respiratory symptoms, including fever, between September 2009 and January 2010. A real-time PCR test was used to definitively diagnose 2009 H1N1 influenza A infection. Medical records of confirmed cases were reviewed for sex, age, and the time of infection. The decision to perform rapid antigen testing was not influenced by clinical conditions, but by individual factors such as economic conditions. Its sensitivity and specificity were evaluated compared to real-time PCR test results. Results : In total, 934 patients tested positive for H1N1 by real-time PCR. The highest number of patients (48.9% was diagnosed in November. Most patients (48.2% were aged between 6 and 10 years. Compared with the H1N1 real-time PCR test results, the rapid antigen test showed 22% sensitivity and 83% specificity. Seventy-eight patients were hospitalized for H1N1 influenza A virus infection, and fever was the most common symptom (97.4%. Conclusion : For diagnosis of 2009 H1N1 influenza A virus infection, the rapid antigen test was inferior to the real-time PCR test in both sensitivity and specificity. This outcome suggests that the rapid antigen test is inappropriate for screening.

Yong-Jae Park

2011-10-01

272

Insufficient preparedness of primary care practices for pandemic influenza and the effect of a preparedness plan in Japan: a prefecture-wide cross-sectional study  

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Background Cases of emerging infectious diseases, including H5N1 influenza, H7N9 influenza, and Middle East Respiratory Syndrome, have been reported in recent years, and the threat of pandemic outbreaks persists. In Japan, primary care is the frontline against emerging infectious diseases in communities. Although the importance of pandemic preparedness in primary care has been highlighted previously, few studies have thus far investigated the preparedness among primary care practices (PCPs) or differences in the preparedness of different institutional settings. We examined PCP preparedness and response to the 2009 influenza pandemic in Japan, and explored the role of a pandemic preparedness plan during the pandemic. Methods We used a survey questionnaire to assess how well individual PCPs in Okinawa, Japan, were prepared for the 2009 influenza pandemic. The questionnaire was mailed to all eligible PCPs (N?=?465) in Okinawa, regardless of their institutional setting. In addition, we assessed the differences in the preparedness of clinics and hospitals and determined whether the national preparedness plan affected individual preparedness and response. Data were analyzed using descriptive and logistic regression analyses. Results A total of 174 (37.4%) PCPs responded to our survey. In general, high-level personal protective equipment (PPE) such as N95 masks (45.4%), gowns (30.5%), and eye protection (21.3%) was stocked at a low rate. Clinic-based PCPs were significantly less prepared than hospital-based PCPs to provide N95 masks (OR 0.34), gowns (OR 0.15), and eye protection (OR 0.18). In addition, only 32.8% of PCPs adopted an adequate business continuity plan (BCP). After controlling for institutional setting, reading the national preparedness plan was significantly associated with establishment of a BCP (OR 5.86), and with knowledge of how to transfer a swab specimen to a local medical laboratory (OR 5.60). Conclusions With regard to PPE availability, PCPs (especially clinic-based PCPs) were not adequately prepared for the influenza pandemic. Awareness of the national pandemic preparedness plan is likely to promote prefecture-wide implementation of BCPs and surveillance activity. PMID:24252688

2013-01-01

273

ASID (HICSIG) position statement: infection control guidelines for patients with influenza-like illnesses, including pandemic (H1N1) influenza 2009, in Australian health care facilities.  

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Standard and Droplet Precautions are considered adequate to control the transmission of influenza in most health care situations. Vaccination of health care staff, carers and vulnerable patients against seasonal and, eventually, pandemic influenza strains is an essential protective strategy. Management principles include: performance of hand hygiene before and after every patient contact or contact with the patient environment, in accord with the national 5 Moments for Hand Hygiene Standard; disinfection of the patient environment; early identification and isolation of patients with suspected or proven influenza; adoption of a greater minimum distance of patient separation (2 metres) than previously recommended; use of a surgical mask and eye protection for personal protection on entry to infectious areas or within 2 metres of an infectious patient; contact tracing for patient and health care staff and restriction of prophylactic antivirals mainly to those at high risk of severe disease; in high aerosol-risk settings, use of particulate mask, eye protection, impervious long-sleeved gown, and gloves donned in that sequence and removed in reverse sequence, avoiding self-contamination; exclusion of symptomatic staff from the workplace until criteria for non-infectious status are met; reserving negative-pressure ventilation rooms (if available) for intensive care patients, especially those receiving non-invasive ventilation; ensuring that infectious postpartum women wear surgical masks when caring for their newborn infants and practise strict hand hygiene; and implementation of special arrangements for potentially infected newborns who require nursery or intensive care. PMID:19835543

Stuart, Rhonda L; Cheng, Allen C; Marshall, Caroline L; Ferguson, John K

2009-10-19

274

In vitro antiviral activity of hypothiocyanite against A/H1N1/2009 pandemic influenza virus.  

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Influenza virus spreads via small particle aerosols, droplets and fomites, and since it can survive for a short time on surfaces, can be introduced into the nasal mucosa before it loses infectivity. The hypothiocyanite ion (OSCN-), product of the lactoperoxidase/H2O2/SCN- system of central airways, is emerging as an important molecule for innate defense mechanism against bacteria, fungi and viruses. Here we demonstrated that OSCN(-) displays virucidal activity in vitro against the A/H1N1 2009 pandemic influenza virus. The concentration required to inhibit viral replication by 50% was 2 ?M when virus were challenged directly with OSCN- before cell inoculation. These values were even lower when inoculated cells were maintained in contact with enzyme free-OSCN- in the culture medium. The last experimental conditions better reflect those of tracheobronchial mucosa, where HOSCN/OSCN- is retained in the air-liquid interface and inactivates both the viruses approaching the epithelium from outside and those released from the inoculated cells after the replication cycle. Importantly no OSCN- cytotoxicity was observed in the cellular system employed. The lack of toxicity in humans and the absence of damage on surfaces of fomites suggest a potential use of OSCN- to avoid mucosal and environmental transmission of influenza virus. Since hypothiocyanite is normally present in human airways a low risk of viral resistance is envisaged. In vivo confirmatory studies are needed to evaluate the appropriate dose, regimen and formulation. PMID:23540488

Cegolon, L; Salata, C; Piccoli, E; Juarez, V; Palu', G; Mastrangelo, G; Calistri, A

2014-01-01

275

Lack of group X secreted phospholipase A? increases survival following pandemic H1N1 influenza infection.  

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The role of Group X secreted phospholipase A2 (GX-sPLA2) during influenza infection has not been previously investigated. We examined the role of GX-sPLA2 during H1N1 pandemic influenza infection in a GX-sPLA2 gene targeted mouse (GX(-/-)) model and found that survival after infection was significantly greater in GX(-/-) mice than in GX(+/+) mice. Downstream products of GX-sPLA2 activity, PGD2, PGE2, LTB4, cysteinyl leukotrienes and Lipoxin A4 were significantly lower in GX(-/-) mice BAL fluid. Lung microarray analysis identified an earlier and more robust induction of T and B cell associated genes in GX(-/-) mice. Based on the central role of sPLA2 enzymes as key initiators of inflammatory processes, we propose that activation of GX-sPLA2 during H1N1pdm infection is an early step of pulmonary inflammation and its inhibition increases adaptive immunity and improves survival. Our findings suggest that GX-sPLA2 may be a potential therapeutic target during influenza. PMID:24725934

Kelvin, Alyson A; Degousee, Norbert; Banner, David; Stefanski, Eva; Le?n, Alberto J; Angoulvant, Denis; Paquette, Stéphane G; Huang, Stephen S H; Danesh, Ali; Robbins, Clinton S; Noyan, Hossein; Husain, Mansoor; Lambeau, Gerard; Gelb, Michael; Kelvin, David J; Rubin, Barry B

2014-04-01

276

The characteristics, clinical manifestations and outcomes of pandemic influenza A (H1N1) 2009 in the elderly  

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Full Text Available SciELO Brazil | Language: English Abstract in english Introduction The objetctive of this study was to evaluate the 2009 Pandemic Influenza A (H1N1) in the elderly and identify the clinical characteristics, mortality and prognostic factors of the infection in these patients. Methods This was an observational, retrospectiv [...] e study. Data were collected from the National Notifiable Diseases (SINAN), from the Brazilian Ministry of Health. Only patients 60 years old or more that had laboratory confirmed infections were included. The socio-demographic and clinical variables and outcomes were evaluated to compare mortality rates in the presence or absence of these factors. Results We included 93 patients in the study, 16.1% of whom died. The symptoms of cough and dyspnea, the use of the antiviral oseltamivir, influenza vaccine and comorbidities influenced the outcomes of cure or death. Chest radiography can aid in diagnosis. Conclusions Although relatively few elderly people were infected, this population presented high lethality that can be justified by the sum of clinical, physical and immunological factors in this population. Treatment with oseltamivir and vaccination against seasonal influenza have significantly reduced rates of hospitalization and mortality.

Luana, Lenzi; Astrid, Wiens; Roberto, Pontarolo.

2013-04-01

277

The characteristics, clinical manifestations and outcomes of pandemic influenza A (H1N1 2009 in the elderly  

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Full Text Available Introduction The objetctive of this study was to evaluate the 2009 Pandemic Influenza A (H1N1 in the elderly and identify the clinical characteristics, mortality and prognostic factors of the infection in these patients. Methods This was an observational, retrospective study. Data were collected from the National Notifiable Diseases (SINAN, from the Brazilian Ministry of Health. Only patients 60 years old or more that had laboratory confirmed infections were included. The socio-demographic and clinical variables and outcomes were evaluated to compare mortality rates in the presence or absence of these factors. Results We included 93 patients in the study, 16.1% of whom died. The symptoms of cough and dyspnea, the use of the antiviral oseltamivir, influenza vaccine and comorbidities influenced the outcomes of cure or death. Chest radiography can aid in diagnosis. Conclusions Although relatively few elderly people were infected, this population presented high lethality that can be justified by the sum of clinical, physical and immunological factors in this population. Treatment with oseltamivir and vaccination against seasonal influenza have significantly reduced rates of hospitalization and mortality.

Luana Lenzi

2013-04-01

278

The characteristics, clinical manifestations and outcomes of pandemic influenza A (H1N1) 2009 in the elderly  

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Full Text Available SciELO Brazil | Language: English Abstract in english Introduction The objetctive of this study was to evaluate the 2009 Pandemic Influenza A (H1N1) in the elderly and identify the clinical characteristics, mortality and prognostic factors of the infection in these patients. Methods This was an observational, retrospectiv [...] e study. Data were collected from the National Notifiable Diseases (SINAN), from the Brazilian Ministry of Health. Only patients 60 years old or more that had laboratory confirmed infections were included. The socio-demographic and clinical variables and outcomes were evaluated to compare mortality rates in the presence or absence of these factors. Results We included 93 patients in the study, 16.1% of whom died. The symptoms of cough and dyspnea, the use of the antiviral oseltamivir, influenza vaccine and comorbidities influenced the outcomes of cure or death. Chest radiography can aid in diagnosis. Conclusions Although relatively few elderly people were infected, this population presented high lethality that can be justified by the sum of clinical, physical and immunological factors in this population. Treatment with oseltamivir and vaccination against seasonal influenza have significantly reduced rates of hospitalization and mortality.

Luana, Lenzi; Astrid, Wiens; Roberto, Pontarolo.

279

Will the NHS continue to function in an influenza pandemic? a survey of healthcare workers in the West Midlands, UK  

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Full Text Available Abstract Background If UK healthcare services are to respond effectively to pandemic influenza, levels of absenteeism amongst healthcare workers (HCWs must be minimised. Current estimates of the likelihood that HCWs will continue to attend work during a pandemic are subject to scientific and predictive uncertainty, yet an informed evidence base is needed if contingency plans addressing the issues of HCW absenteeism are to be prepared. Methods This paper reports the findings of a self-completed survey of randomly selected HCWs across three purposively sampled healthcare trusts in the West Midlands. The survey aimed to identify the factors positively or negatively associated with willingness to work during an influenza pandemic, and to evaluate the acceptability of potential interventions or changes to working practice to promote the continued presence at work of those otherwise unwilling or unable to attend. 'Likelihood' and 'persuadability' scores were calculated for each respondent according to indications of whether or not they were likely to work under different circumstances. Binary logistic regression was used to compute bivariate and multivariate odds ratios to evaluate the association of demographic variables and other respondent characteristics with the self-described likelihood of reporting to work. Results The survey response rate was 34.4% (n = 1032. Results suggest absenteeism may be as high as 85% at any point during a pandemic, with potential absence particularly concentrated amongst nursing and ancillary workers (OR 0.3; 95% CI 0.1 to 0.7 and 0.5; 95% CI 0.2 to 0.9 respectively. Conclusion Levels of absenteeism amongst HCWs may be considerably higher than official estimates, with potential absence concentrated amongst certain groups of employees. Although interventions designed to minimise absenteeism should target HCWs with a low stated likelihood of working, members of these groups may also be the least receptive to such interventions. Changes to working conditions which reduce barriers to the ability to work may not address barriers linked to willingness to work, and may fail to overcome HCWs' reluctance to work in the face of what may still be deemed unacceptable risk to self and/or family.

Parry Jayne

2009-05-01

280

Building an insurance against modern pandemics.  

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The response to the first influenza pandemic of the 21st century benefited from the extensive preparation for an avian influenza pandemic and the mild nature of the 2009 A/H1N1 swine influenza virus. However, the pandemic demonstrated the limited ability to predict influenza pandemics, to anticipate levels of cross-protection, and to deliver vaccines in a timely manner, particularly to low income countries. The lessons learned from the 2009 H1N1 pandemic are of paramount importance to develop more effective preparations against future pandemics. PMID:20112161

Rappuoli, Rino; Medini, Duccio; Siena, Emilio; Budroni, Sonia; Dormitzer, Philip R; Del Giudice, Giuseppe

2010-02-01

 
 
 
 
281

Effects of vitamin D supplements on influenza A illness during the 2009 H1N1 pandemic: a randomized controlled trial.  

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In a prior randomized trial, we found that the incidence of influenza A was less in the vitamin D3 group than among those on placebo, but the total incidence of either influenza A or B did not differ between groups. In this trial, the incidence of influenza A or B was less in the vitamin D3 group than in the placebo group only during the first half of the study. To elucidate whether vitamin D3 has preventive actions against influenza A, we conducted another trial during the 2009 pandemic of the H1N1 subtype of influenza A. Students (n = 247) of a Japanese high school were randomly assigned to receive vitamin D3 supplements (n = 148; 2000 IU per day) or a placebo (n = 99) in a double-blind study for 2 months. The primary outcome was incidence of influenza A diagnosed by a rapid influenza diagnostic test by medical doctors. Influenza A was equally likely in the vitamin D3 group (20/148: 13.5%) compared with the placebo group (12/99: 12.1%). By post hoc analysis, influenza A occurred significantly less in the vitamin D3 group (2/148: 1.4%) compared with the placebo group (8/99: 8.1%) (risk ratio, 0.17; 95% confidence interval, 0.04 to 0.77; P = 0.009) in the first month. However, during the second month, the vitamin D3 group experienced more events and effectively caught up with the placebo group. Vitamin D3 supplementation did not lower the overall incidence of influenza A during the 2009 H1N1 pandemic. A post hoc analysis suggests that the initial benefit during the first month of treatment was lost during the second month. PMID:25088394

Urashima, Mitsuyoshi; Mezawa, Hidetoshi; Noya, Miki; Camargo, Carlos A

2014-09-01

282

Influenza pandémica a un año de la primera ola: ¿Qué podemos decir ahora? / Pandemic influenza one year after the first wave: What did we learn?  

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Full Text Available SciELO Chile | Language: Spanish Abstract in spanish Durante el año 2009 nuestro país vivió la primera ola pandémica causada por el nuevo virus de influenza A (H1N1) 2009 aparecido en el hemisferio norte a fines de abril del ese año. La tasa de ataque estimada fue entre 6 a 12% afectando más frecuentemente a los escolares quienes presentaron una enfer [...] medad leve. Los grupos etáreos con mayor riesgo de hospitalización fueron los adultos mayores y los niños bajo 5 años de edad. Tuvieron mayor riesgo de fallecer los adultos mayores y aquellas personas con una co-morbilidad asociada. Aprendimos que el diagnóstico clínico de influenza se confirma por laboratorio en alrededor del 80% pero tiene una baja correlación en los niños bajo 5 años de edad, especialmente en lactantes bajo 1 año de edad, al circular concomitantemente con VRS. Los métodos de diagnóstico como la IFD y los inmunocromatográficos tienen una sensibilidad que no supera el 80% y es muy baja en los adultos mayores cuando se compara con PCR. Dado el impacto clínico de este nuevo virus se justifica el uso de vacunación en los grupos de riesgo previamente descritos y el tratamiento con antivirales en los pacientes que cursan con enfermedad grave o con riesgo de evolucionar a una enfermedad más complicada. Abstract in english During year 2009 our nation experimented the first influenza pandemic wave due to the novel influenza A (H1N1) 2009 virus that emerged in the Northern hemisphere at the end of April, 2009. Estimated attack rate was about 6 to 12% affecting mainly to schoolchildren who presented with a mild disease. [...] Age groups with highest risk of hospitalization were elderly people and children under 5 years old. Elderly patients and patients with co-morbidities had the highest risk to die. We have learnt that clinical diagnosis of influenza has a laboratory confirmation in about 80% of cases but its correlation is lower in kids under 5 years old, especially in infants when RSV co-circulates with influenza virus. Laboratory diagnostic methods like DFA and immuno-cromatography have about 80% of sensitivity but a significantly lower rate in elderly patients compared to PCR. The clinical impact of this new virus justifies the recommendation to vaccinate traditionally established risk groups and to prescribe antiviral treatment to patients that acquire severe influenza or have risk factors to progress to complications.

Cecilia, Perret P.

2010-04-01

283

Influenza pandémica a un año de la primera ola: ¿Qué podemos decir ahora? Pandemic influenza one year after the first wave: What did we learn?  

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Full Text Available Durante el año 2009 nuestro país vivió la primera ola pandémica causada por el nuevo virus de influenza A (H1N1 2009 aparecido en el hemisferio norte a fines de abril del ese año. La tasa de ataque estimada fue entre 6 a 12% afectando más frecuentemente a los escolares quienes presentaron una enfermedad leve. Los grupos etáreos con mayor riesgo de hospitalización fueron los adultos mayores y los niños bajo 5 años de edad. Tuvieron mayor riesgo de fallecer los adultos mayores y aquellas personas con una co-morbilidad asociada. Aprendimos que el diagnóstico clínico de influenza se confirma por laboratorio en alrededor del 80% pero tiene una baja correlación en los niños bajo 5 años de edad, especialmente en lactantes bajo 1 año de edad, al circular concomitantemente con VRS. Los métodos de diagnóstico como la IFD y los inmunocromatográficos tienen una sensibilidad que no supera el 80% y es muy baja en los adultos mayores cuando se compara con PCR. Dado el impacto clínico de este nuevo virus se justifica el uso de vacunación en los grupos de riesgo previamente descritos y el tratamiento con antivirales en los pacientes que cursan con enfermedad grave o con riesgo de evolucionar a una enfermedad más complicada.During year 2009 our nation experimented the first influenza pandemic wave due to the novel influenza A (H1N1 2009 virus that emerged in the Northern hemisphere at the end of April, 2009. Estimated attack rate was about 6 to 12% affecting mainly to schoolchildren who presented with a mild disease. Age groups with highest risk of hospitalization were elderly people and children under 5 years old. Elderly patients and patients with co-morbidities had the highest risk to die. We have learnt that clinical diagnosis of influenza has a laboratory confirmation in about 80% of cases but its correlation is lower in kids under 5 years old, especially in infants when RSV co-circulates with influenza virus. Laboratory diagnostic methods like DFA and immuno-cromatography have about 80% of sensitivity but a significantly lower rate in elderly patients compared to PCR. The clinical impact of this new virus justifies the recommendation to vaccinate traditionally established risk groups and to prescribe antiviral treatment to patients that acquire severe influenza or have risk factors to progress to complications.

Cecilia Perret P

2010-04-01

284

The elusive definition of pandemic influenza / L'insaisissable définition de la grippe pandémique / La evasiva definición de la gripe pandémica  

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Full Text Available SciELO Public Health | Language: English Abstract in spanish Durante el pasado año, fundamentalmente en Europa, se generó una considerable polémica sobre si la Organización Mundial de la Salud (OMS) habría cambiado su definición de gripe pandémica en el año 2009, tras la identificación de la nueva gripe H1N1. Algunos argumentan que no solo se cambió la defini [...] ción, sino que se hizo para despejar el camino hacia la declaración de una pandemia. Otros aseguran que la definición nunca se cambió y que esta alegación está completamente infundada. Estos puntos de vista tan opuestos han dificultado nuestra capacidad para extraer conclusiones relevantes. Este callejón sin salida, unido a las preocupaciones sobre los posibles conflictos de intereses y las dudas sobre la proporcionalidad de la respuesta al brote de la gripe H1N1, ha menoscabado la confianza de la población en los responsables de la salud y en nuestra capacidad colectiva para responder con eficacia a futuras amenazas de este tipo. La OMS no cambió su definición de gripe pandémica por el simple motivo de que nunca antes había definido formalmente el concepto de gripe pandémica. Si bien la OMS ha propuesto numerosas descripciones de gripe pandémica, nunca estableció una definición formal y los criterios para la declaración de una pandemia provocada por el virus H1N1 procedían de las definiciones de «fase de alerta pandémica», no de una definición de «gripe pandémica». El hecho de no contar con una definición formal de gripe pandémica, a pesar del bagaje de los diez años de actividades de preparación contra las pandemias, revela importantes suposiciones subyacentes sobre la naturaleza de esta enfermedad infecciosa. En particular, las limitaciones de los enfoques «centrados en el virus» reclaman una mayor atención y se debe informar sobre los esfuerzos que se realicen para «aprender las lecciones» que dirijan nuestra respuesta ante los futuros brotes de nuevas enfermedades infecciosas. Abstract in english There has been considerable controversy over the past year, particularly in Europe, over whether the World Health Organization (WHO) changed its definition of pandemic influenza in 2009, after novel H1N1 influenza was identified. Some have argued that not only was the definition changed, but that it [...] was done to pave the way for declaring a pandemic. Others claim that the definition was never changed and that this allegation is completely unfounded. Such polarized views have hampered our ability to draw important conclusions. This impasse, combined with concerns over potential conflicts of interest and doubts about the proportionality of the response to the H1N1 influenza outbreak, has undermined the public trust in health officials and our collective capacity to effectively respond to future disease threats. WHO did not change its definition of pandemic influenza for the simple reason that it has never formally defined pandemic influenza. While WHO has put forth many descriptions of pandemic influenza, it has never established a formal definition and the criteria for declaring a pandemic caused by the H1N1 virus derived from "pandemic phase" definitions, not from a definition of "pandemic influenza". The fact that despite ten years of pandemic preparedness activities no formal definition of pandemic influenza has been formulated reveals important underlying assumptions about the nature of this infectious disease. In particular, the limitations of "virus-centric" approaches merit further attention and should inform ongoing efforts to "learn lessons" that will guide the response to future outbreaks of novel infectious diseases.

Peter, Doshi.

285

Human antibodies reveal a protective epitope that is highly conserved among human and nonhuman influenza A viruses.  

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Influenza remains a serious public health threat throughout the world. Vaccines and antivirals are available that can provide protection from infection. However, new viral strains emerge continuously because of the plasticity of the influenza genome, which necessitates annual reformulation of vaccine antigens, and resistance to antivirals can appear rapidly and become entrenched in circulating virus populations. In addition, the spread of new pandemic strains is difficult to contain because of the time required to engineer and manufacture effective vaccines. Monoclonal antibodies that target highly conserved viral epitopes might offer an alternative protection paradigm. Herein we describe the isolation of a panel of monoclonal antibodies derived from the IgG(+) memory B cells of healthy, human subjects that recognize a previously unknown conformational epitope within the ectodomain of the influenza matrix 2 protein, M2e. This antibody binding region is highly conserved in influenza A viruses, being present in nearly all strains detected to date, including highly pathogenic viruses that infect primarily birds and swine, and the current 2009 swine-origin H1N1 pandemic strain (S-OIV). Furthermore, these human anti-M2e monoclonal antibodies protect mice from lethal challenges with either H5N1 or H1N1 influenza viruses. These results suggest that viral M2e can elicit broadly cross-reactive and protective antibodies in humans. Accordingly, recombinant forms of these human antibodies may provide useful therapeutic agents to protect against infection from a broad spectrum of influenza A strains. PMID:20615945

Grandea, Andres G; Olsen, Ole A; Cox, Thomas C; Renshaw, Mark; Hammond, Philip W; Chan-Hui, Po-Ying; Mitcham, Jennifer L; Cieplak, Witold; Stewart, Shaun M; Grantham, Michael L; Pekosz, Andrew; Kiso, Maki; Shinya, Kyoko; Hatta, Masato; Kawaoka, Yoshihiro; Moyle, Matthew

2010-07-13

286

Epidemiological aspects of influenza A related to climatic conditions during and after a pandemic period in the city of Salvador, northeastern Brazil  

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Full Text Available SciELO Brazil | Language: English Abstract in english During the influenza pandemic of 2009, the A(H1N1)pdm09, A/H3N2 seasonal and influenza B viruses were observed to be co-circulating with other respiratory viruses. To observe the epidemiological pattern of the influenza virus between May 2009-August 2011, 467 nasopharyngeal aspirates were collected [...] from children less than five years of age in the city of Salvador. In addition, data on weather conditions were obtained. Indirect immunofluorescence, real-time transcription reverse polymerase chain reaction (RT-PCR), and sequencing assays were performed for influenza virus detection. Of all 467 samples, 34 (7%) specimens were positive for influenza A and of these, viral characterisation identified Flu A/H3N2 in 25/34 (74%) and A(H1N1)pdm09 in 9/34 (26%). Influenza B accounted for a small proportion (0.8%) and the other respiratory viruses for 27.2% (127/467). No deaths were registered and no pattern of seasonality or expected climatic conditions could be established. These observations are important for predicting the evolution of epidemics and in implementing future anti-pandemic measures.

Rosangela de Castro, Silva; Marilda Agudo Mendonça, Siqueira; Eduardo Martins, Netto; Jacione Silva, Bastos; Cristiana Maria, Nascimento-Carvalho; Ana Luisa, Vilas-Boas; Maiara Lana, Bouzas; Fernando do Couto, Motta; Carlos, Brites.

287

Epidemiological aspects of influenza A related to climatic conditions during and after a pandemic period in the city of Salvador, northeastern Brazil  

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Full Text Available SciELO Brazil | Language: English Abstract in english During the influenza pandemic of 2009, the A(H1N1)pdm09, A/H3N2 seasonal and influenza B viruses were observed to be co-circulating with other respiratory viruses. To observe the epidemiological pattern of the influenza virus between May 2009-August 2011, 467 nasopharyngeal aspirates were collected [...] from children less than five years of age in the city of Salvador. In addition, data on weather conditions were obtained. Indirect immunofluorescence, real-time transcription reverse polymerase chain reaction (RT-PCR), and sequencing assays were performed for influenza virus detection. Of all 467 samples, 34 (7%) specimens were positive for influenza A and of these, viral characterisation identified Flu A/H3N2 in 25/34 (74%) and A(H1N1)pdm09 in 9/34 (26%). Influenza B accounted for a small proportion (0.8%) and the other respiratory viruses for 27.2% (127/467). No deaths were registered and no pattern of seasonality or expected climatic conditions could be established. These observations are important for predicting the evolution of epidemics and in implementing future anti-pandemic measures.

Rosangela de Castro, Silva; Marilda Agudo Mendonça, Siqueira; Eduardo Martins, Netto; Jacione Silva, Bastos; Cristiana Maria, Nascimento-Carvalho; Ana Luisa, Vilas-Boas; Maiara Lana, Bouzas; Fernando do Couto, Motta; Carlos, Brites.

2014-04-01

288

Toll-like receptor 3 gene polymorphisms and severity of pandemic A/H1N1/2009 influenza in otherwise healthy children  

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Full Text Available Abstract Background Toll-like receptors (TLRs form an essential part of the innate immune system, which plays a fundamental role in rapidly and effectively controlling infections and initiating adaptive immunity. There are no published data concerning the importance of polymorphisms of TLRs in conditioning susceptibility to influenza or the severity of the disease. The aim of this study was to evaluate whether selected polymorphisms of TLR2, TLR3 and TLR4 influence the incidence and clinical picture of pandemic A/H1N1/2009 influenza. Results The study involved 272 healthy children attending our Emergency Room for influenza-like illness (ILI, including 51 (18.8% with pandemic A/H1N1/2009 influenza as revealed by real-time polymerase chain reaction, and 164 healthy controls examined after minor surgery. Genomic DNA was extracted from whole blood samples and five single-nucleotide polymorphisms (SNPs were studied: TLR2 rs5743708, TLR3 rs5743313, TLR3 rs5743315, TLR4 rs4986790 and TLR4 rs4986791. The TLR3 rs5743313/CT polymorphism was found in all of the children with pneumonia and influenza infection, but in a significantly smaller number of those with A/H1N1/2009 influenza without pneumonia ( Conclusions There is a close relationship between the presence of TLR3 rs5743313/CT and an increased risk of pneumonia in children infected by the pandemic A/H1N1/2009 influenza virus.

Esposito Susanna

2012-11-01

289

Molecular characterization of circulating pandemic strains of influenza A virus during 2012 to 2013 in Lucknow (India).  

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The pandemic H1N1 strain of Influenza A virus [A(H1N1)pdm09] is now well adapted in human populations. However, it is still causing sporadic outbreaks worldwide with different severity. The present study was planned to understand the genetic diversity (based on the HA1 gene) of influenza A(H1N1)pdm09 strains circulating during the post pandemic period. The HA1 gene was selected because the HA1 protein is immunogenic, functions as a receptor binding site and indirectly affects transmission and pathogenicity of virus. A total of 2,818 cases were enrolled. Nasal/throat swabs from all cases were tested by one-step real time PCR for detection of influenza virus types and subtypes according to the CDC protocol. Of these, 134 cases were A(H1N1)pdm09 positive, 34 of which were screened for HA1 gene (position 434-905) sequencing (Big-Dye terminator using 3130 ABI, Genetic analyzer). Molecular and phylogenetic analysis was performed using PhyML approach (v. 3.0). All A(H1N1)pdm09 positive and negative cases were clinically characterized. Phylogentically, all Lucknow strains (n?=?33) except one fall with the clade seven reference strain. One strain showed 99.9% similarities with clade one reference strain A/California/07/2009. In mutational analysis, 33 strains had the S220T mutation, which is at an antigenic site and characteristic of clade seven along with few minor mutations; K180I/T/Q, V190I, S200P, S202T, A203T, A214T, S220T, V251I, and A273T. These results suggest that clade seven was the most widely circulating clade in Lucknow and A(H1N1)pdm09 cases showed mild clinical symptoms as compared to A(H3N2) or influenza B cases. J. Med. Virol. 86:2134-2141, 2014. © 2014 Wiley Periodicals, Inc. PMID:24777528

Dangi, Tanushree; Jain, Bhawana; Singh, Ajay Kumar; Singh, J V; Kumar, Rashmi; Dwivedi, Mukesh; Verma, Anil Kumar; Chadha, Mandeep S; Jain, Amita

2014-12-01

290

Identification of a linear epitope on the haemagglutinin protein of pandemic A/H1N1 2009 influenza virus using monoclonal antibodies.  

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A novel influenza A/H1N1 virus, emerging from Mexico and the United States in the spring of 2009, caused the pandemic human infection of 2009-2010. The haemagglutinin (HA) glycoprotein is the major surface antigen of influenza A virus and plays an important role in viral infection. In this study, three hybridoma cell lines secreting specific monoclonal antibodies (Mabs) against the HA protein of pandemic influenza A/H1N1 2009 virus were generated with the recombinant plasmid pCAGGS-HA as an immunogen. Using Pepscan analysis, the binding sites of these Mabs were identified in a linear region of the HA protein. Further, refined mapping was conducted using truncated peptides expressed as GST-fusion proteins in E. coli. We found that the (250)VPRYA(254) motif was the minimal determinant of the linear epitope that could be recognized by the Mabs. Alignment with sequences from the databases showed that the amino acid residues of this epitope were highly conserved among all pandemic A/H1N1 2009 viruses as well as the classical swine H1N1 viruses isolated to date. These results provide additional insights into the antigenic structure of the HA protein and virus-antibody interactions at the amino acid level, which may assist in the development of specific diagnostic methods for influenza viruses. PMID:24385157

Chen, Yan; Zhang, Jian; Qiao, Chuanling; Wang, Jingfei; Yang, Huanliang; Chen, Hualan

2014-06-01

291

The first wave of pandemic influenza (H1N1 2009 in Germany: From initiation to acceleration  

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Full Text Available Abstract Background The first imported case of pandemic influenza (H1N1 2009 in Germany was confirmed in April 2009. However, the first wave with measurable burden of disease started only in October 2009. The basic epidemiological and clinical characteristics of the pandemic were analysed in order to understand the course of the pandemic in Germany. Methods The analysis was based on data from the case-based, mandatory German surveillance system for infectious diseases. Cases notified between 27 April and 11 November 2009 and fulfilling the case definition were included in the study. Results Two time periods with distinct epidemiologic characteristics could be determined: 23,789 cases (44.1% occurred during the initiation period (IP, week 18 to 41, and 30,179 (55.9% during the acceleration period (AP, week 42 to 45. During IP, coinciding with school summer holidays, 61.1% of cases were travel-related and one death occurred. Strict containment efforts were performed until week 32. During AP the majority of cases (94.3% was autochthonous, 12 deaths were reported. The main affected age group shifted from 15 to 19 years in IP to 10 to 14 years in AP (median age 19 versus 15 years; p Conclusion The epidemiological differences we could show between summer and autumn 2009 might have been influenced by the school summer holidays and containment efforts. The spread of disease did not result in change of risk groups or severity. Our results show that analyses of case-based information can advise future public health measures.

Altmann Doris

2010-06-01

292

Reassortant swine influenza viruses isolated in Japan contain genes from pandemic A(H1N1) 2009.  

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In 2013, three reassortant swine influenza viruses (SIVs)-two H1N2 and one H3N2-were isolated from symptomatic pigs in Japan; each contained genes from the pandemic A(H1N1) 2009 virus and endemic SIVs. Phylogenetic analysis revealed that the two H1N2 viruses, A/swine/Gunma/1/2013 and A/swine/Ibaraki/1/2013, were reassortants that contain genes from the following three distinct lineages: (i) H1 and nucleoprotein (NP) genes derived from a classical swine H1 HA lineage uniquely circulating among Japanese SIVs; (ii) neuraminidase (NA) genes from human-like H1N2 swine viruses; and (iii) other genes from pandemic A(H1N1) 2009 viruses. The H3N2 virus, A/swine/Miyazaki/2/2013, comprised genes from two sources: (i) hemagglutinin (HA) and NA genes derived from human and human-like H3N2 swine viruses and (ii) other genes from pandemic A(H1N1) 2009 viruses. Phylogenetic analysis also indicated that each of the reassortants may have arisen independently in Japanese pigs. A/swine/Miyazaki/2/2013 were found to have strong antigenic reactivities with antisera generated for some seasonal human-lineage viruses isolated during or before 2003, whereas A/swine/Miyazaki/2/2013 reactivities with antisera against viruses isolated after 2004 were clearly weaker. In addition, antisera against some strains of seasonal human-lineage H1 viruses did not react with either A/swine/Gunma/1/2013 or A/swine/Ibaraki/1/2013. These findings indicate that emergence and spread of these reassortant SIVs is a potential public health risk. PMID:24750464

Kanehira, Katsushi; Takemae, Nobuhiro; Uchida, Yuko; Hikono, Hirokazu; Saito, Takehiko

2014-06-01

293

Surveillance of hospitalizations with pandemic A(H1N1 2009 influenza infection in Queensland, Australia  

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Full Text Available Objective : To describe the demographic and clinical characteristics of patients hospitalized with pandemic A(H1N1 2009 infection in Queensland, Australia between 25 May and 3 October 2009 and to examine the relationship between timing of antiviral treatment and severity of illness.Method: Using data from the Queensland Health EpiLog information system, descriptive analysis and logistic regression modelling were used to describe and model factors which influence patient outcomes (death, admission to intensive care unit and/or special care unit. Data on patients admitted to hospital in Queensland with confirmed pandemic A(H1N1 2009 infection were included in this analysis.Results: 1236 patients with pandemic A(H1N1 2009 infection were admitted to hospitals in Queensland during the study period. Of the total group: 15% were admitted to an intensive care unit or special care unit; 3% died; 34% were under the age of 18 years and 8% were 65 years of age or older; and 55% had at least one underlying medical condition. Among the 842 patients for whom data were available regarding the use of antiviral drugs, antiviral treatment was initiated in 737 (87.5% patients with treatment commencing at a median of one day (range 1–33 days after onset of illness. Admission to an intensive care unit or special care unit (ICU/SCU or death was significantly associated with increased age, lack of timeliness of antiviral treatment, chronic renal disease and morbid obesity.Discussion: Early antiviral treatment was significantly associated with lower likelihood of ICU/SCU admission or death. Early antiviral treatment for influenza cases may therefore have important public health implications.

Frances Birrell

2011-05-01

294

A proposed non-consequentialist policy for the ethical distribution of scarce vaccination in the face of an influenza pandemic.  

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The current UK policy for the distribution of scarce vaccination in an influenza pandemic is ethically dubious. It is based on the planned outcome of the maximum health benefit in terms of the saving of lives and the reduction of illness. To that end, the population is classified in terms of particular priority groups. An alternative policy with a non-consequentialist rationale is proposed in the present work. The state should give the vaccination, in the first instance, to those who are at risk of catching the pandemic flu in the line of their duties of public employment. Thereafter, if there is not sufficient vaccine to give all citizens equally an effective dose, the state should give all citizens an equal chance of receiving an effective dose. This would be the just thing to do because the state has a duty to treat each and all of its citizens impartially and they have a corresponding right to such impartial treatment. Although this article specifically refers to the UK, it is considered that the suggested alternative policy would be applicable generally. The duty to act justly is not merely a local one. PMID:22411748

McLachlan, Hugh V

2012-05-01

295

CLINICAL CHARACTERIZATION OF H1N1 INFLUENZA TAQMAN REAL TIME PCR POSITIVE CASES  

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Full Text Available Background: A novel swine origin influenza virus (H1N1 is spreading worldwide and become the first pandemic of the 21st century. The currently circulating strain of swine origin influenza virus of the H1N1 strain has undergone triple reassortment and contains genes from the avian, swine and human viruses. H1N1 critical illness mostly affects young patients and it is often fatal. Aim: The aim of the present study is to evaluate the clinical characteristic of H1N1 infection in a tertiary care institute. Material & Methods: A total of 251 pharyangeal and nasal swabs from suspected cases of swineflu were processed by TaqMan real-time PCR (CDC protocol. Clinical co-relation with presenting sign and symptoms and analysis was done. Results: 36 (14% were confirmed as positive. The clinical picture was characterized by fever (88%, cough (94%, sorethroat (35%, nasal catarrh (51%, chest pain (0.4%. Chest X-ray findings suggested association of consolidation with positive cases (47%. Discussion: Strong clinical association is seen in those who were It was also noted that 2009 H1N1 influenza illness predominantly affects young patients. Conclusion: The knowledge and technology translation previously acquired through courses by health care providers were the key in controlling the first influenza A (H1N1 2009 cases. Hospitalized cases of H1N1 influeza should be monitored carefully and vaccination is a good alternative to control such pandemic. [National J of Med Res 2012; 2(1.000: 12-14

Sangita Revdiwala

2012-02-01

296

Tracking oseltamivir-resistance in New Zealand influenza viruses during a medicine reclassification in 2007, a resistant-virus importation in 2008 and the 2009 pandemic  

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Full Text Available Introduction: Oseltamivir (Tamiflu® is an important pharmaceutical intervention against the influenza virus. The importance of surveillance for resistance to oseltamivir has been highlighted by two global events: the emergence of an oseltamivir-resistant seasonal influenza A(H1N1 virus in 2008, and emergence of the influenza A(H1N1pdm09 virus in 2009. Oseltamivir is a prescription medicine in New Zealand, but more timely access has been provided since 2007 by allowing pharmacies to directly dispense oseltamivir to patients with influenza-like illness.Objective: To determine the frequency of oseltamivir-resistance in the context of a medicine reclassification in 2007, the importation of an oseltamivir-resistant seasonal influenza virus in 2008, and the emergence of a pandemic in 2009.Methods: A total of 1795 influenza viruses were tested for oseltamivir-resistance using a fluorometric neuraminidase inhibition assay. Viruses were collected as part of a sentinel influenza surveillance programme between the years 2006 and 2010.Results: All influenza B, influenza A(H3N2 and influenza A(H1N1pdm09 viruses tested between 2006 and 2010 were shown to be sensitive to oseltamivir. Seasonal influenza A(H1N1 viruses from 2008 and 2009 were resistant to oseltamivir. Sequencing of the neuraminidase gene showed that the resistant viruses contained an H275Y mutation, and S247N was also identified in the neuraminidase gene of one seasonal influenza A(H1N1 virus that exhibited enhanced resistance.Discussion: No evidence was found to suggest that increased access to oseltamivir has promoted resistance. A probable importation event was documented for the global 2008 oseltamivir-resistant seasonal A(H1N1 virus nine months after it was first reported in Europe in January 2008.

Q Sue Huang

2012-10-01

297

Chile entre pandemias: la influenza de 1918, globalización y la nueva medicina / Chile between pandemic: the influenza of 1918, globalization and the new medicine  

Scientific Electronic Library Online (English)

Full Text Available SciELO Chile | Language: Spanish Abstract in spanish En 1918 Chile conoció la mortífera presencia de la influenza española, la pandemia más importante del siglo XX. Para muchos historiadores, ese evento es un importante hito en el proceso histórico de la unificación del mundo a través de las enfermedades y en el cual nuestro país ha sido partícipe. En [...] ese contexto, el presente artículo pretende examinar la forma en que la gripe irrumpió en la sociedad chilena y cómo esa coyuntura contribuyó a dar un nuevo impulso a la modernización de la salud pública chilena y a la instauración en la década de 1920 al modelo de la nueva medicina o medicina preventiva. Abstract in english In 1918 Chile met the deadly presence of the Spanish influenza pandemic twentieth century's most important. For many historians, this event is an important milestone in the historical process of the unification of the world through sickness and in which our country has been involved. In this context [...] , this paper aims to examine how the flu broke into Chilean society and how that situation helped give new impetus to the modernization of the Chilean public health and the establishment in the 1920s to model new medicine or preventive medicine.

Marcelo, López; Miriam, Beltrán.

298

Serological report of pandemic and seasonal human influenza virus infection in dogs in southern China.  

Science.gov (United States)

From January to July 2012, we looked for evidence of subclinical A (H1N1) pdm09 and seasonal human influenza viruses infections in healthy dogs in China. Sera from a total of 1920 dogs were collected from Guangdong, Guangxi, Fujian and Jiangxi provinces. We also examined archived sera from 66 dogs and cats that were collected during 2008 from these provinces. Using hemagglutination inhibition (HI) and microneutralization (MN) assays, we found that only the dogs sampled in 2012 had elevated antibodies (?1:32) against A(H1N1)pdm09 virus and seasonal human influenza viruses: Of the 1920 dog sera, 20.5 % (n = 393) had elevated antibodies against influenza A(H1N1) pdm09 by the HI assay, 1.1 % (n = 22), and 4.7 % (n = 91) of the 1920 dogs sera had elevated antibodies against human seasonal H1N1 influenza virus and human seasonal H3N2 influenza virus by the HI assay. Compared with dogs that were raised on farms, dogs that were raised as pets were more likely to have elevated antibodies against A(H1N1)pdm09 and seasonal human influenza viruses. Seropositivity was highest among pet dogs, which likely had more diverse and frequent exposures to humans than farm dogs. These findings will help us better understand which influenza A viruses are present in dogs and will contribute to the prevention and control of influenza A virus. Moreover, further in-depth study is necessary for us to understand what roles dogs play in the ecology of influenza A. PMID:24965232

Yin, Xin; Zhao, Fu-Rong; Zhou, Dong-Hui; Wei, Ping; Chang, Hui-Yun

2014-11-01

299

Clinical manifestations, therapy and outcome of pandemic influenza a (H1N1 2009 in hospitalized patients  

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Full Text Available Background/Aim. Increasing number of epidemiological and clinical studies to date showed that the pandemic influenza A (H1N1 2009, by its characteristics, significantly differs from infection caused by seasonal influenza. Therefore, the information about clinical spectrum of manifestations, risk factors for severe form of the disease, treatment and outcome in patients with novel flu are still collected. Methods. A total of 98 patients (mean age 32 ± 15 years, range 14-88 years with the signs and symptoms of novel influenza were treated in the Clinic for Infectious and Tropical Diseases, Military Medical Academy. There were 74 (75.5% patients with suspected influenza A (H1N1 2009, 10 (10.2% with the likelihood and 14 (14.3% with the confirmed influenza. In all the patients we registered the basic demographic data, risk factors for severe disease, symptoms and signs of influenza, laboratory tests and chest radiography. We analyzed antiviral therapy use and disease outcome (survived, died. Results. The average time from the beginning of influenza A (H1N1 to the admission in hospital was 3 days (0-16 days and from the moment of hospitalization to the Intensive Care Unit (ICU admission was 2 days (0-5 days. There were 49 (50.0% patients, 20-29 years of age and 5 (5.1% patients older than 65. A total of 21 (21.4% patients were with underlying disease, 18 (18.4% were obese, 19 (19.4% were cigarette smokers. All of the patients had fever, 81 (82.6% cough, while dyspnea and diarrhea were registered in ¼ of the patients. In more than 75% of the patients laboratory tests were within normal limits. The realtime polymerase chain reaction (PCR test for identification of influenza A (H1N1 2009 was positive in 14 (77.8%, while pneumonia was verified in 30 (30.7% of the patients. Six (6.1% patients, mean age of 45 ± 14 years (31-59 years were admitted to the ICU, of whom five (5.1% had Adult Respiratory Distress Syndrome (ARDS. Risk factors were registered more frequently in the patients with acute respiratory failure (14.2% vs 4.9%, p < 0.05. A total of 67 (68.4% patients received oseltamivir, 89 (90.1% was applied to antibiotics and 64 (65.3% were treated with a combined therapy. Antiviral therapy was applied to 43 (43.3% patients in the first 48 hours from the onset of the disease, of whom only one (3.4% developed ARDS. Fatal outcome was noted in 2.0% of the patients (2 of 98 patients and in 33.3% of the patients treated in the ICU. Conclusion. Novel influenza A (H1N1 is most commonly manifested as a mild acute respiratory disease, which usually affects young healthy adults. A small number of the patients develop severe illness with acute respiratory failure and death. Patients seem to have benefit from antiviral therapy especially in first 48 hours.

Miki? Dragan

2011-01-01

300

Assessing the impact of public health interventions on the transmission of pandemic H1N1 influenza a virus aboard a Peruvian navy ship  

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Background Limited data exist on transmission dynamics and effectiveness of control measures for influenza in confined settings. Objectives To investigate the transmission dynamics of a 2009 pandemic H1N1 influenza A outbreak aboard a Peruvian Navy ship and quantify the effectiveness of the implemented control measures. Methods We used surveillance data and a simple stochastic epidemic model to characterize and evaluate the effectiveness of control interventions implemented during an outbreak of 2009 pandemic H1N1 influenza A aboard a Peruvian Navy ship. Results The serological attack rate for the outbreak was 49·1%, with younger cadets and low-ranking officers at greater risk of infection than older, higher-ranking officers. Our transmission model yielded a good fit to the daily time series of new influenza cases by date of symptom onset. We estimated a reduction of 54·4% in the reproduction number during the period of intense control interventions. Conclusion Our results indicate that the patient isolation strategy and other control measures put in place during the outbreak reduced the infectiousness of isolated individuals by 86·7%. Our findings support that early implementation of control interventions can limit the spread of influenza epidemics in confined settings. PMID:24506160

Vera, Delphis M; Hora, Ricardo A; Murillo, Anarina; Wong, Juan F; Torre, Armando J; Wang, David; Boulay, Darbi; Hancock, Kathy; Katz, Jacqueline M; Ramos, Mariana; Loayza, Luis; Quispe, Jose; Reaves, Erik J; Bausch, Daniel G; Chowell, Gerardo; Montgomery, Joel M

2014-01-01

 
 
 
 
301

Clinical features and risk factors for severe and critical pregnant women with 2009 pandemic H1N1 influenza infection in China  

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Abstract Background 2009 pandemic H1N1 (pH1N1) influenza posed an increased risk of severe illness among pregnant women. Data on risk factors associated with death of pregnant women and neonates with pH1N1 infections are limited outside of developed countries. Methods Retrospective observational study in 394 severe or critical pregnant women admitted to a hospital with pH1N1 influenza from Sep. 1, 2009 to Dec. 31, 2009. rRT-PCR testing was used to confirm infect...

Zhang Peng-jun; Li Xiao-li; Cao Bin; Yang Shi-gui; Liang Li-rong; Gu Li; Xu Zhen; Hu Ke; Zhang Hong-yuan; Yan Xi-xin; Huang Wen-bao; Chen Wei; Zhang Jing-xiao; Li Lan-juan; Wang Chen

2012-01-01

302

Estimating the value of containment strategies in delaying the arrival time of an influenza pandemic: A case study of travel restriction and patient isolation  

CERN Document Server

With a simple phenomenological metapopulation model, which characterizes the invasion process of an influenza pandemic from a source to a subpopulation at risk, we compare the efficiency of inter- and intra-population interventions in delaying the arrival of an influenza pandemic. We take travel restriction and patient isolation as examples, since in reality they are typical control measures implemented at the inter- and intra-population levels, respectively. We find that the intra-population interventions, e.g., patient isolation, perform better than the inter-population strategies such as travel restriction if the response time is small. However, intra-population strategies are sensitive to the increase of the response time, which might be inevitable due to socioeconomic reasons in practice and will largely discount the efficiency.

Wang, Lin; Huang, Tianyi; Li, Xiang; 10.1103/PhysRevE.86.032901

2012-01-01

303

Phylogenetic analysis of H1N1 sequences from pandemic infections during 2009 in India.  

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Since April 2009, a serious pandemic infection has been rapidly spread across the world. These infections are caused due to the novel swine origin influenza A (H1N1) virus and hence these are commonly called as "Swine Flu". This new virus is the reassortment of avian, human and swine influenza viruses and thus it has a unique genome composition. There are 16 different types of hemagglutinin (HA) and 9 different types of neuraminidase (NA) that can be genetically and antigenetically differentiated. The first influenza A virus isolated from pigs was of the H1N1 subtype and these viruses have been reported to cause infection in pigs in many countries. The outbreak of this virus has been transmitted from pigs to humans. This new reassorted (exchange of genes) virus which is the cause of 2009 pandemic infections has the ability to spread from human to human. This spread of infection should be brought to an end. In this study, a phylogenetic analysis of the nucleotide sequences of the RNA segments of human H1N1 viruses was carried using MEGA version 4.0 to demonstrate the route map of infection to India. Phylogenetic analysis of the sequences from India, published in Influenza Virus Resource (a database that integrates information gathered from the Influenza Genome Sequencing Project of the National Institute of Allergy and Infectious diseases (NIAID) and the genbank of the (NCBI)) was retrieved and used for the analysis. The results showed that the various segments of the Indian isolates clustered well with the sequences from American, Asian and European countries and thus indicating the transmission of viruses from these places to India. PMID:21423887

Flavia, Guntupally Balaswamy Arti; Natarajaseenivasan, Kalimuthusamy

2011-01-01

304

Modeling the impact of air, sea, and land travel restrictions supplemented by other interventions on the emergence of a new influenza pandemic virus  

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Full Text Available Abstract Background During the early stages of a new influenza pandemic, travel restriction is an immediate and non-pharmaceutical means of retarding incidence growth. It extends the time frame of effective mitigation, especially when the characteristics of the emerging virus are unknown. In the present study, we used the 2009 influenza A pandemic as a case study to evaluate the impact of regulating air, sea, and land transport. Other government strategies, namely, antivirals and hospitalizations, were also evaluated. Methods Hong Kong arrivals from 44 countries via air, sea, and land transports were imported into a discrete stochastic Susceptible, Exposed, Infectious and Recovered (SEIR host-flow model. The model allowed a number of latent and infectious cases to pass the border, which constitutes a source of local disease transmission. We also modeled antiviral and hospitalization prevention strategies to compare the effectiveness of these control measures. Baseline reproduction rate was estimated from routine surveillance data. Results Regarding air travel, the main route connected to the influenza source area should be targeted for travel restrictions; imposing a 99% air travel restriction delayed the epidemic peak by up to two weeks. Once the pandemic was established in China, the strong land connection between Hong Kong and China rendered Hong Kong vulnerable. Antivirals and hospitalization were found to be more effective on attack rate reductions than travel restrictions. Combined strategies (with 99% restriction on all transport modes deferred the peak for long enough to establish a vaccination program. Conclusion The findings will assist policy-makers with decisions on handling similar future pandemics. We also suggest regulating the extent of restriction and the transport mode, once restriction has been deemed necessary for pandemic control. Although travel restrictions have yet to gain social acceptance, they allow time for mitigation response when a new and highly intrusive virus emerges.

Chong Ka Chun

2012-11-01

305

The European Union faces up to the threat of a pandemic: meeting at the DGV on the influenza A (H5N1) of the ad hoc group on communicable diseases Luxembourg 14 January 1998.  

Science.gov (United States)

The transmission of an avian influenza H5N1 virus to a child in Hong Kong in May 1997 followed by the occurrence of 17 other human cases with a high case fatality rate (6/18, 33%) suggested that an influenza pandemic could be imminent and led many Europea PMID:12631777

Desenclos, J-C.; Manigat, R

1998-03-01

306

Inicio del brote de Influenza A (H1N1) pandémica en Chile: caracterización genética de los primeros casos detectados / Genetic characterization of the virus causing H1N1 influenza pandemic in Chile: Analysis of the first detected cases  

Scientific Electronic Library Online (English)

Full Text Available SciELO Chile | Language: Spanish Abstract in spanish [...] Abstract in english Background: Following the announcement of the Influenza A(H1N1) pandemic by the World Health Organization in April 2009, a surveillance program was carried out in Chile to detect the introduction of the virus in the country and to monitor its propagation and impact. Aim: To describe the onset of the [...] outbreak and the genetic characterization of the pandemic H1N1 influenza virus in the first detected cases in Chile. Material and Methods: Analysis of18 clinical samples coming from suspicious patients, received in a National Reference Laboratory. RNA reverse transcription and real time influenza gene DNA amplification was carried out in a 7500 Fast and Step One Real Time PCR Systems of Applied Biosystems and MxPro-Mx3000P thermocycler from Stratagene. Super Script III Platinum One-Step Quantitative RT-PCR was used. Results: The virus was first detected in three persons returning from the Dominican Republic via Panamá and a child from the east zone of Santiago. Genetic characterization of the virus showed that the child was infected by a different variant of the pandemic virus than the three persons returning from the Caribbean. Conclusions: The onset of the Influenza outbreak in Chile apparently carne from two different epidemiological groups. The spread of the virus detected in the voyagers was limited immediately However the virus of the fourth case was found in different regions of Chile.

RODRIGO A, FASCE; JAVIER, TOGNARELLI; JUDITH, MORA; GRACIELA, TORRES; WINSTON, ANDRADE; PATRICIA, BUSTOS; PAMELA, ARAYA; MONSERRAT, BALANDA; CAROLINA, AGUAYO; JORGE, SEIN; EUGENIO, RAMÍREZ; JORGE, FERNÁNDEZ.

307

Recommended Mitigation Measures for an Influenza Pandemic in Remote and Isolated First Nations Communities of Ontario, Canada: A Community-Based Participatory Research Approach  

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Full Text Available Influenza pandemics disproportionately impact remote and/or isolated Indigenous communities worldwide. The differential risk experienced by such communities warrants the recommendation of specific mitigation measures. Interviewer-administered questionnaires were conducted with adult key health care informants from three remote and isolated Canadian First Nations communities of sub-Arctic Ontario. Forty-eight mitigation measures (including the setting, pandemic period, trigger, and duration were questioned. Participants’ responses were summarized and collected data were deductively and inductively coded. The participants recommended 41 of the questioned mitigation measures, and often differed from previous literature and national recommendations. Results revealed that barriers, such as overcrowded housing, limited supplies, and health care infrastructure, impacted the feasibility of implementing mitigation measures. These findings suggest that pandemic plans should recommend control strategies for remote and isolated Canadian First Nations communities that may not be supported in other communities. These findings highlight the importance of engaging locally impacted populations using participatory approaches in policy decision-making processes. Other countries with remote and/or isolated Indigenous communities are encouraged to include recommendations for mitigation measures that specifically address the unique needs of such communities in an effort to improve their health outcomes during the next influenza pandemic.

Nadia A. Charania

2014-06-01

308

Responding to pandemic (H1N1) 2009 influenza in Aboriginal communities in NSW through collaboration between NSW Health and the Aboriginal community-controlled health sector.  

Science.gov (United States)

As a vulnerable population, Aboriginal people in NSW were thought likely to be at more risk of serious illness from pandemic (H1N1) 2009 influenza than non-Aboriginal people. As such, the importance of consulting with Aboriginal people and communities was recognised early in the pandemic. This consultation was to enable key messages to be disseminated appropriately and to facilitate access to health care. Key stakeholders in the response were the NSW Department of Health, Area Health Services, the NSW Aboriginal Health and Medical Research Council, and Aboriginal Community Controlled Health Services. Regular teleconferences between the key stakeholders facilitated the flow of information and assisted with the identification of issues. A consultation process between Hunter New England Area Health Service and six Aboriginal communities helped inform the development of resources as well as the planning and delivery of pandemic-related services. Aboriginal people were four times more likely to be admitted to hospital with pandemic (H1N1) 2009 influenza than non-Aboriginal people. PMID:20374691

Rudge, Sian; Massey, Peter D

2010-01-01

309

Factors Affecting the Acceptance of Pandemic Influenza A H1N1 Vaccine amongst Essential Service Providers: A Cross Sectional Study  

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Full Text Available Although mentioned in the UK pandemic plan, essential service providers were not among the priority groups. They may be important targets of future influenza pandemic vaccination campaigns. Therefore, we conducted a cross-sectional survey among 380 employees from West Midlands police headquarters and 15 operational command units in the West Midlands Area during December 2009–February 2010 to identify factors affecting intention to accept the pandemic influenza A (H1N1 vaccine. One hundred and ninety nine (52.4% employees completed the questionnaire. 39.7% were willing to accept the vaccine. The most common reasons for intention to accept were worry about catching Swine Flu (n = 42, 53.2% and about infecting others (n = 40, 50.6%. The most common reason for declination was worry about side effects (n = 45, 57.0%. The most important factor predicting vaccine uptake was previous receipt of seasonal vaccine (OR 7.9 (95% CI 3.4, 18.5. Employees aged <40 years, males, current smokers, and those who perceived a greater threat and severity of swine flu were also more likely to agree to the vaccine. The findings of this study could be used to improve future pandemic immunization strategies. Targeted education programs should be used to address misconceptions; the single most important factor which might lead to a large improvement in uptake is to allay concern about side effects.

Charlotte Roberts

2012-12-01

310

Using surveillance data to estimate pandemic vaccine effectiveness against laboratory confirmed influenza A(H1N12009 infection: two case-control studies, Spain, season 2009-2010  

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Full Text Available Abstract Background Physicians of the Spanish Influenza Sentinel Surveillance System report and systematically swab patients attended to their practices for influenza-like illness (ILI. Within the surveillance system, some Spanish regions also participated in an observational study aiming at estimating influenza vaccine effectiveness (cycEVA study. During the season 2009-2010, we estimated pandemic influenza vaccine effectiveness using both the influenza surveillance data and the cycEVA study. Methods We conducted two case-control studies using the test-negative design, between weeks 48/2009 and 8/2010 of the pandemic season. The surveillance-based study included all swabbed patients in the sentinel surveillance system. The cycEVA study included swabbed patients from seven Spanish regions. Cases were laboratory-confirmed pandemic influenza A(H1N12009. Controls were ILI patients testing negative for any type of influenza. Variables collected in both studies included demographic data, vaccination status, laboratory results, chronic conditions, and pregnancy. Additionally, cycEVA questionnaire collected data on previous influenza vaccination, smoking, functional status, hospitalisations, visits to the general practitioners, and obesity. We used logistic regression to calculate adjusted odds ratios (OR, computing pandemic influenza vaccine effectiveness as (1-OR*100. Results We included 331 cases and 995 controls in the surveillance-based study and 85 cases and 351 controls in the cycEVA study. We detected nine (2.7% and two (2.4% vaccine failures in the surveillance-based and cycEVA studies, respectively. Adjusting for variables collected in surveillance database and swabbing month, pandemic influenza vaccine effectiveness was 62% (95% confidence interval (CI: -5; 87. The cycEVA vaccine effectiveness was 64% (95%CI: -225; 96 when adjusting for common variables with the surveillance system and 75% (95%CI: -293; 98 adjusting for all variables collected. Conclusion Point estimates of the pandemic influenza vaccine effectiveness suggested a protective effect of the pandemic vaccine against laboratory-confirmed influenza A(H1N12009 in the season 2009-2010. Both studies were limited by the low vaccine coverage and the late start of the vaccination campaign. Routine influenza surveillance provides reliable estimates and could be used for influenza vaccine effectiveness studies in future seasons taken into account the surveillance system limitations.

Savulescu Camelia

2011-11-01

311

Pandemic influenza vaccine: characterization of A/California/07/2009 (H1N1 recombinant hemagglutinin protein and insights into H1N1 antigen stability  

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Full Text Available Abstract Background The recent H1N1 influenza pandemic illustrated the shortcomings of the vaccine manufacturing process. The A/California/07/2009 H1N1 pandemic influenza vaccine or A(H1N1pdm09 was available late and in short supply as a result of delays in production caused by low yields and poor antigen stability. Recombinant technology offers the opportunity to shorten manufacturing time. A trivalent recombinant hemagglutinin (rHA vaccine candidate for seasonal influenza produced using the baculovirus expression vector system (BEVS was shown to be as effective and safe as egg-derived trivalent inactivated vaccine (TIV in human clinical studies. In this study, we describe the characterization of the A/California/07/2009 rHA protein and compare the H1N1 pandemic rHA to other seasonal rHA proteins. Results Our data show that, like other rHA proteins, purified A/California/07/2009 rHA forms multimeric rosette-like particles of 20–40?nm that are biologically active and immunogenic in mice as assayed by hemagglutination inhibition (HAI antibody titers. However, proteolytic digest analysis revealed that A/California/07/2009 rHA is more susceptible to proteolytic degradation than rHA proteins derived from other seasonal influenza viruses. We identified a specific proteolytic site conserved across multiple hemagglutinin (HA proteins that is likely more accessible in A/California/07/2009 HA, possibly as a result of differences in its protein structure, and may contribute to lower antigen stability. Conclusion We conclude that, similar to the recombinant seasonal influenza vaccine, recombinant A(H1N1pdm09 vaccine is likely to perform comparably to licensed A(H1N1pdm09 vaccines and could offer manufacturing advantages.

Feshchenko Elena

2012-10-01

312

In vitro activity of favipiravir and neuraminidase inhibitor combinations against oseltamivir-sensitive and oseltamivir-resistant pandemic influenza A (H1N1) virus.  

Science.gov (United States)

Few anti-influenza drugs are licensed in the United States for the prevention and therapy of influenza A and B virus infections. This shortage, coupled with continuously emerging drug resistance, as detected through a global surveillance network, seriously limits our anti-influenza armamentarium. Combination therapy appears to offer several advantages over traditional monotherapy in not only delaying development of resistance but also potentially enhancing single antiviral activity. In the present study, we evaluated the antiviral drug susceptibilities of fourteen pandemic influenza A (H1N1) virus isolates in MDCK cells. In addition, we evaluated favipiravir (T-705), an investigational drug with a broad antiviral spectrum and a unique mode of action, alone and in dual combination with the neuraminidase inhibitors (NAIs) oseltamivir, peramivir, or zanamivir, against oseltamivir-sensitive pandemic influenza A/California/07/2009 (H1N1) and oseltamivir-resistant A/Hong Kong/2369/2009 (H1N1) virus. Mean inhibitory values showed that the tested virus isolates remained sensitive to commonly used antiviral drugs, with the exception of the Hong Kong virus isolate. Drug dose-response curves confirmed complete drug resistance to oseltamivir, partial sensitivity to peramivir, and retained susceptibility to zanamivir and favipiravir against the A/Hong Kong/2369/2009 virus. Three-dimensional analysis of drug interactions using the MacSynergy(TM) II program indicated an overall synergistic interaction when favipiravir was combined with the NAIs against the oseltamivir-sensitive influenza virus, and an additive effect against the oseltamivir-resistant virus. Although the clinical relevance of these drug combinations remains to be evaluated, results obtained from this study support the use of combination therapy with favipiravir and NAIs for treatment of human influenza virus infections. PMID:24311151

Tarbet, E Bart; Vollmer, Almut H; Hurst, Brett L; Barnard, Dale L; Furuta, Yousuke; Smee, Donald F

2014-06-01

313

The reporting of the influenza pandemic, 1918-1920 in Hamilton, Ontario  

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Full Text Available The paper evaluates the ways in which Hamilton, Ontario’s three daily newspapers covered the influenza epidemic, 1918-1920. In Hamilton, the central aspect of influenza coverage was Dr. Roberts’ decision to close all public meeting places twice during 1918. No other story but those connected to a public meeting ban could sustain interest. Thus, the story for the press was to be the ban: whether to ban, what to ban, to lift or not, to reimpose. The story monopolized influenza coverage to such an extent that traditional threads, such as morbidity and mortality and personal interest stories, received little attention. The ban, because it restricted personal freedoms and involved local politics and commerce, received extensive coverage. In the absence of a ban, the influenza story could fade out of the press even during some of the most virulent periods of the epidemic. The paper finds that influenza was not transformative in Hamilton and in fact, demonstrated the viability of traditional charitable responses to disease. The actions carried out by Hamilton’s Board of Health cannot be considered “modern” as its methods were more akin to the nineteenth century than those of the later bacteriological age.

John Rankin

2012-12-01

314

Influenza and Other Respiratory Viruses Involved in Severe Acute Respiratory Disease in Northern Italy during the Pandemic and Postpandemic Period (2009-2011)  

Science.gov (United States)

Since 2009 pandemic, international health authorities recommended monitoring severe and complicated cases of respiratory disease, that is, severe acute respiratory infection (SARI) and acute respiratory distress syndrome (ARDS). We evaluated the proportion of SARI/ARDS cases and deaths due to influenza A(H1N1)pdm09 infection and the impact of other respiratory viruses during pandemic and postpandemic period (2009–2011) in northern Italy; additionally we searched for unknown viruses in those cases for which diagnosis remained negative. 206 respiratory samples were collected from SARI/ARDS cases and analyzed by real-time RT-PCR/PCR to investigate influenza viruses and other common respiratory pathogens; also, a virus discovery technique (VIDISCA-454) was applied on those samples tested negative to all pathogens. Influenza A(H1N1)pdm09 virus was detected in 58.3% of specimens, with a case fatality rate of 11.3%. The impact of other respiratory viruses was 19.4%, and the most commonly detected viruses were human rhinovirus/enterovirus and influenza A(H3N2). VIDISCA-454 enabled the identification of one previously undiagnosed measles infection. Nearly 22% of SARI/ARDS cases did not obtain a definite diagnosis. In clinical practice, great efforts should be dedicated to improving the diagnosis of severe respiratory disease; the introduction of innovative molecular technologies, as VIDISCA-454, will certainly help in reducing such “diagnostic gap.” PMID:25013770

Pariani, Elena; Jazaeri Farsani, Seyed Mohammad; Oude Munnink, Bas B.; Deijs, Martin; Zanetti, Alessandro; van der Hoek, Lia

2014-01-01

315

Impacto clínico de la influenza A H1N1 pandémica en el hospital de Puerto Montt, Chile / Clinical impact of pandemic influenza A H1N1 in a Chilean regional hospital  

Scientific Electronic Library Online (English)

Full Text Available SciELO Chile | Language: Spanish Abstract in spanish [...] Abstract in english Background: Pandemic flu (H1N1 ) strongly affected southern Chile during2009. Aim: To report the logistic and organizational changes implemented at a regional hospital to face the pandemic. Material and Methods: All patients with flu like disease that were hospitalized, were prospectively enrolled a [...] t the Puerto Montt hospital. A nasopharyngeal aspirate was obtained in all for influenza virus A and B direct immunofluorescence and polymerase chain reaction (PCR). All epidemiological and clinical data of patients were recorded. Results: Between May 29 and July 7, 2009, 184 adults were admitted to the hospital and in 117patients aged 41 ± 18 years (56% females ), direct immunofluorescence was positive for influenza. In 67 of these patients PCR did not confirm the disease. These unconfirmed patients had a mean age of 49 ± 19 years (p

Raúl, Riquelme O; Mauricio, Riquelme O; María Luisa, Rioseco Z; Carlos, Inzunza P; Cristian, Contreras G; Yarella, Gómez V; Javier, Riquelme D.

316

Outbreaks of influenza A virus in farmed mink (Neovison vison) in Denmark: molecular characterization of the viruses  

DEFF Research Database (Denmark)

Influenza in mink (Neovison vison) is assumed to be rare, but several outbreaks have been described during recent years in Europe and the North America. In 2009, influenza A of the subtype H3N2 was detected in several Danish mink farms with respiratory symptoms. Full-genome sequencing showed that the virus was a human/swine reassortant, with the H and N gene most related to human H3N2 viruses circulating in 2005. The remaining 6 genes were most closely related to H1N2 influenza viruses circulating in Danish swine. This virus had not previously been described in swine, mink or humans. PCRs assays specifically targeting the new reassortant were developed and used to screen influenza positive samples from humans and swine in Denmark with negative results. Thus, there was no evidence that this virus had spread to humans or was circulating in Danish pigs. In 2010 and 2011, influenza virus was again diagnosed in diseased mink in a few farms. The genetic typing showed that the virus was similar to the pandemic H1N1 virus circulating in humans and swine. The H3N2 virus was not detected in 2010 and 2011. Taken together, these findings indicate that mink is highly susceptible for influenza A virus of human and swine origin and may therefore act as a potential host/reservoir for influenza A viruses.

Larsen, Lars Erik; Breum, Solvej Østergaard

2012-01-01

317

Outbreaks of Influenza A Virus in Farmed Mink (Neovison vison) in Denmark: Molecular characterization of the involved viruses  

DEFF Research Database (Denmark)

Influenza in mink (Neovison vison) is assumed to be rare, but outbreaks have previously been reported in farmed mink. The first report was from Swedish mink farms in 1984 and the second was reported from Canadian mink farms. In 2009, influenza A of the subtype H3N2 was detected in several Danish mink farms with respiratory symptoms. Full-genome sequencing showed that the virus was a human/swine reassortant, with the H and N gene most related to human H3N2 viruses circulating in 2005. The remaining 6 genes were most closely related to H1N2 influenza viruses circulating in Danish swine. This virus had not previously been described in swine, mink nor humans. PCRs assays specifically targeting the new reassortant were developed and used to screen influenza positive samples from humans and swine in Denmark with negative results. Thus, there was no evidence that this virus had spread to humans or was circulating in Danish pigs. In 2010 and 2011, influenza virus was again diagnosed in diseased mink in a fewfarms. The genetic typing showed that the virus was similar to the pandemic H1N1 virus circulating in humans and swine. The H3N2 virus was not detected in 2010 and 2011. Taken together, these findings indicate that mink is highly susceptible for influenza A virus of human and swine origin and may therefore act as a potential host/reservoir for influenza A viruses.

Larsen, Lars Erik; Breum, Solvej Østergaard

318

Spontaneous reporting of adverse events following pandemic influenza A (H1N1) immunization in a reference center in the State of Sao Paulo, Brazil  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in english Introduction This paper describes adverse events (AEs) temporally associated to the pandemic influenza A (H1N1) vaccine observed in a reference center in São Paulo, Brazil, during a 2010 mass vaccination campaign. Methods A retrospective study involving persons who sought medical care for AEs fol [...] lowing influenza vaccination. Data were retrieved from medical records, vaccine AE notification forms, and a computerized system for immunobiological registration. Results Sixty-six vaccinees sought medical care for AEs after immunization. The most frequent AEs were fever, headache, myalgia, and pain at the injection site. No serious AEs were reported. Conclusions Few vaccinees spontaneously reported AEs to influenza A (H1N1) vaccine at this center.

Danise Senna, Oliveira; Amanda Nazareth, Lara; Andre Machado, Luiz; Karina Takesaki, Miyaji; Ana Marli Christovam, Sartori; Marta Heloisa, Lopes.

2013-06-01

319

Evidence of person-to-person transmission of oseltamivir-resistant pandemic influenza A(H1N1) 2009 virus in a hematology unit.  

Science.gov (United States)

We describe the first confirmed person-to-person transmission of oseltamivir-resistant pandemic influenza A(H1N1) 2009 virus that occurred in a hematology unit in the United Kingdom. Eleven cases of (H1N1) 2009 virus infection were identified, of which, ten were related as shown by sequence analysis of the hemagglutinin and neuraminidase genes. H275Y analysis demonstrated that 8 of 10 case patients had oseltamivir-resistant virus, with 4 of 8 case patients infected by direct transmission of resistant virus. Zanamivir should be considered as first-line therapy for influenza in patients with lymphopenic hematological conditions and uptake of influenza vaccination encouraged to further reduce the number of susceptible individuals. PMID:21148492

Moore, Catherine; Galiano, Monica; Lackenby, Angie; Abdelrahman, Tamer; Barnes, Rosemary; Evans, Meirion R; Fegan, Christopher; Froude, Susannah; Hastings, Mark; Knapper, Steven; Litt, Emma; Price, Nicola; Salmon, Roland; Temple, Mark; Davies, Eleri

2011-01-01

320

Spontaneous reporting of adverse events following pandemic influenza A (H1N1) immunization in a reference center in the State of Sao Paulo, Brazil  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in english Introduction This paper describes adverse events (AEs) temporally associated to the pandemic influenza A (H1N1) vaccine observed in a reference center in São Paulo, Brazil, during a 2010 mass vaccination campaign. Methods A retrospective study involving persons who sought medical care for AEs fol [...] lowing influenza vaccination. Data were retrieved from medical records, vaccine AE notification forms, and a computerized system for immunobiological registration. Results Sixty-six vaccinees sought medical care for AEs after immunization. The most frequent AEs were fever, headache, myalgia, and pain at the injection site. No serious AEs were reported. Conclusions Few vaccinees spontaneously reported AEs to influenza A (H1N1) vaccine at this center.

Danise Senna, Oliveira; Amanda Nazareth, Lara; Andre Machado, Luiz; Karina Takesaki, Miyaji; Ana Marli Christovam, Sartori; Marta Heloisa, Lopes.

 
 
 
 
321

High genetic compatibility and increased pathogenicity of reassortants derived from avian H9N2 and pandemic H1N1/2009 influenza viruses.  

Science.gov (United States)

H9N2 influenza viruses have been circulating worldwide in multiple avian species and repeatedly infecting mammals, including pigs and humans, posing a significant threat to public health. The coexistence of H9N2 and pandemic influenza H1N1/2009 viruses in pigs and humans provides an opportunity for these viruses to reassort. To evaluate the potential public risk of the reassortant viruses derived from these viruses, we used reverse genetics to generate 127 H9 reassortants derived from an avian H9N2 and a pandemic H1N1 virus, and evaluated their compatibility, replication ability, and virulence in mice. These hybrid viruses showed high genetic compatibility and more than half replicated to a high titer in vitro. In vivo studies of 73 of 127 reassortants revealed that all viruses were able to infect mice without prior adaptation and 8 reassortants exhibited higher pathogenicity than both parental viruses. All reassortants with higher virulence than parental viruses contained the PA gene from the 2009 pandemic virus, revealing the important role of the PA gene from the H1N1/2009 virus in generating a reassortant virus with high public health risk. Analyses of the polymerase activity of the 16 ribonucleoprotein combinations in vitro suggested that the PA of H1N1/2009 origin also enhanced polymerase activity. Our results indicate that some avian H9-pandemic reassortants could emerge with a potentially higher threat for humans and also highlight the importance of monitoring the H9-pandemic reassortant viruses that may arise, especially those that possess the PA gene of H1N1/2009 origin. PMID:21368167

Sun, Yipeng; Qin, Kun; Wang, Jingjing; Pu, Juan; Tang, Qingdong; Hu, Yanxin; Bi, Yuhai; Zhao, Xueli; Yang, Hanchun; Shu, Yuelong; Liu, Jinhua

2011-03-01

322

Vaccination of Patients with Mild and Severe Asthma with a 2009 Pandemic H1N1 Influenza Virus Vaccine  

Science.gov (United States)

BACKGROUND Asthma was the most common comorbidity of patients hospitalized with 2009 H1N1 influenza. OBJECTIVE To assess immunogenicity and safety of an unadjuvanted, inactivated 2009 H1N1 vaccine in severe versus mild/moderate asthma. METHODS We conducted an open-label study involving 390 participants (age:12–79y) enrolled in October-November 2009. Severe asthma was defined as need for ?880mcg/d of inhaled fluticasone equivalent and/or systemic corticosteroids. Within each severity group, participants were randomized to receive intramuscularly 15mcg or 30mcg of 2009 H1N1 vaccine twice, 21 days apart. Immunogenicity endpoints were seroprotection (?40 titer in hemagglutination inhibition assay) and seroconversion (4-fold or greater titer increase). Safety was assessed through local and systemic reactogenicity, asthma exacerbations and pulmonary function. RESULTS In mild/moderate asthma (N=217), the 2009 H1N1 vaccine provided equal seroprotection 21 days after the first immunization at the 15mcg (90.6%,CI:83.5–95.4) and 30mcg (95.3%,CI:89.4–98.5) doses. In severe asthma (N=173), seroprotection 21 days after the first immunization was 77.9% (CI:67.7–86.1) and 94.1% (CI:86.8–98.1) at the 15mcg and 30mcg dose, respectively (p=0.004). The second vaccination did not provide further increases in seroprotection. Participants with severe asthma ?60y showed the lowest seroprotection (44.4% at Day 21) with the 15mcg dose, but had adequate seroprotection with 30mcg. The two dose groups did not differ in seroconversion rates. There were no safety concerns. CONCLUSION Monovalent inactivated 2009 H1N1 pandemic influenza vaccine was safe and provided overall seroprotection as a surrogate of efficacy. In severe asthma participants over 60y, a 30mcg dose may be more appropriate. PMID:21145578

Busse, William W.; Peters, Stephen P.; Fenton, Matthew J.; Mitchell, Herman; Bleecker, Eugene R.; Castro, Mario; Wenzel, Sally; Erzurum, Serpil C.; Fitzpatrick, Anne M.; Teague, W. Gerald; Jarjour, Nizar; Moore, Wendy C.; Sumino, Kaharu; Simeone, Scott; Ratanamaneechat, Suphagaphan; Penugonda, Madhuri; Gaston, Benjamin; Ross, Ted M.; Sigelman, Steve; Schiepan, Joella R.; Zaccaro, Daniel J.; Crevar, Corey J.; Carter, Donald M.; Togias, Alkis

2010-01-01

323

Rhinoviruses delayed the circulation of the pandemic influenza A (H1N1) 2009 virus in France.  

Science.gov (United States)

In contrast to the experience in other European countries, the onset of the A(H1N1)2009 influenza virus epidemic was unexpectedly slow in France during the first part of autumn 2009. Our objective was to test the hypothesis that intense circulation of rhinoviruses might have reduced the probability of infection by A(H1N1)2009 virus at the beginning of autumn 2009. Systematic analysis for the detection of A(H1N1)2009 (H1N1) and human rhinovirus (HRV) was performed by RT-PCR from week 36 to week 48 on respiratory samples sent to the diagnostic laboratory by the paediatric hospital (n = 2121). Retrospective analysis of the obtained data, using 2 x 2 contingency tables with Fisher's exact test, revealed evidence of an inverse relationship between HRV and H1N1 detection. Between weeks 36 and 48 of 2009, both HRV and H1N1 were detected but in different time frames. HRV dispersed widely during early September, peaking at the end of the month, whereas the H1N1 epidemic began during mid-October and was still active at the end of this survey. During the co-circulation period of these two respiratory viruses (weeks 43-46), HRV detection appeared to reduce the likelihood of H1N1 detection in the same sample (OR = 0.08-0.24 p <0.0001). These results support the hypothesis that HRV infections can reduce the probability of A(H1N1) infection. This viral interference between respiratory viruses could have affected the spread of the H1N1 viruses and delayed the influenza pandemic at the beginning of autumn in France. PMID:20121829

Casalegno, J S; Ottmann, M; Duchamp, M Bouscambert; Escuret, V; Billaud, G; Frobert, E; Morfin, F; Lina, B

2010-04-01

324

Preterm Infant Born to a Mother with Severe Pandemic H1N1 Influenza  

Digital Repository Infrastructure Vision for European Research (DRIVER)

H1N1 pandemic infection, emerging this year has aroused great fear and anxiety all over the world and in our country. As known in the medical literature, H1N1 virus infections are more severe in pregnant women . Severe respiratory failure, abortion, preterm delivery and even death may occur. Transplacental transition from the infected mother to the fetus has not been shown so far. The findings of a preterm infant who was born to a mother with pulmonary failure due to severe H1N1 infection ...

Sezgin Güne?; Betul Siyah Bilgin; Mehmet Yalaz; Mete Akisu; Mete Ergeno?lu; Nilgün Kültürsay

2011-01-01

325

Pandemic 2009 Influenza A (H1N1) virus infection in cancer and hematopoietic stem cell transplant recipients; a multicenter observational study.  

Science.gov (United States)

Background: During March 2009 a novel Influenza A virus emerged in Mexico. We describe the clinical picture of the pandemic Influenza A (H1N1) Influenza in cancer patients during the 2009 influenza season. Methods: Twelve centers participated in a multicenter retrospective observational study of cancer patients with confirmed infection with the 2009 H1N1 Influenza A virus (influenza-like illness or pneumonia plus positive PCR for the 2009 H1N1 Influenza A virus  in respiratory secretions). Clinical data were obtained by retrospective chart review and analyzed.  Results: From May to August 2009, data of 65 patients were collected. Median age was 51 years, 57 % of the patients were female. Most patients (47) had onco-hematological cancers and 18 had solid tumors. Cancer treatment mainly consisted of chemotherapy (46), or stem cell transplantation (SCT) (16). Only 19 of 64 patients had received the 2009 seasonal Influenza vaccine. Clinical presentation included pneumonia (43) and upper respiratory tract infection (22). Forty five of 58 ambulatory patients were admitted. Mechanical ventilation was required in 12 patients (18%). Treatment included oseltamivir monotherapy or in combination with amantadine for a median of 7 days. The global 30-day mortality rate was 18%. All 12 deaths were among the non-vaccinated patients. No deaths were observed among the 19 vaccinated patients. Oxygen saturation Influenza A (H1N1) virus was associated with high incidence of pneumonia (66%), and 30-day mortality (18.5%). Saturation <96% was significantly associated with death. No deaths were observed among vaccinated patients.

Dignani, Maria Cecilia; Costantini, Patricia; Salgueira, Claudia; Jordán, Rosana; Guerrini, Graciela; Valledor, Alejandra; Herrera, Fabián; Nenna, Andrea; Mora, Claudia; Roccia-Rossi, Inés; Stecher, Daniel; Carbone, Edith; Laborde, Ana; Efron, Ernesto; Altclas, Javier; Calmaggi, Aníbal; Cozzi, José

2014-01-01

326

Caveolin-1 influences human influenza A virus (H1N1 multiplication in cell culture  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background The threat of recurring influenza pandemics caused by new viral strains and the occurrence of escape mutants necessitate the search for potent therapeutic targets. The dependence of viruses on cellular factors provides a weak-spot in the viral multiplication strategy and a means to interfere with viral multiplication. Results Using a motif-based search strategy for antiviral targets we identified caveolin-1 (Cav-1 as a putative cellular interaction partner of human influenza A viruses, including the pandemic influenza A virus (H1N1 strains of swine origin circulating from spring 2009 on. The influence of Cav-1 on human influenza A/PR/8/34 (H1N1 virus replication was determined in inhibition and competition experiments. RNAi-mediated Cav-1 knock-down as well as transfection of a dominant-negative Cav-1 mutant results in a decrease in virus titre in infected Madin-Darby canine kidney cells (MDCK, a cell line commonly used in basic influenza research as well as in virus vaccine production. To understand the molecular basis of the phenomenon we focussed on the putative caveolin-1 binding domain (CBD located in the lumenal, juxtamembranal portion of the M2 matrix protein which has been identified in the motif-based search. Pull-down assays and co-immunoprecipitation experiments showed that caveolin-1 binds to M2. The data suggest, that Cav-1 modulates influenza virus A replication presumably based on M2/Cav-1 interaction. Conclusion As Cav-1 is involved in the human influenza A virus life cycle, the multifunctional protein and its interaction with M2 protein of human influenza A viruses represent a promising starting point for the search for antiviral agents.

Hemgård Gun-Viol

2010-05-01

327

Surveillance of adverse events following immunization against pandemic influenza in Slovenia in season 2009/10.  

Science.gov (United States)

The results of Slovenian surveillance system of AEFI which was in place for the early detection and investigation of rare adverse events were analysed. The reports about AEFI obtained from physicians, and self-assessment questionnaires from vaccinated persons showed predominantly non-serious and expected side effects. Nine reports (3%) included serious AEFI. No deaths consequent to vaccination were reported. A total of 1170 AEFI were reported by physicians and 1030 by self-assessment. Overall, the most commonly reported AEFI either by physicians or persons were local site reactions (37.3% and 50.5%), tiredness (11.9% and 6.8%) and fever or malaise (10.8% and 6.3%). More than 100,000 people were vaccinated with pandemic vaccines in Slovenia. The type and the frequency of AEFI detected through Slovenian AEFI surveillance system are comparable to the results from other surveillance systems. The benefit-risk balance for the pandemic vaccines used in Slovenia remains positive. PMID:20598408

Kraigher, Alenka; Ucakar, Veronika

2010-07-26

328

Prediction of Clinical Factors Associated with Pandemic Influenza A (H1N1) 2009 in Pakistan  

Science.gov (United States)

Background Influenza is a viral infection that can lead to serious complications and death(s) in vulnerable groups if not diagnosed and managed in a timely manner. This study was conducted to improve the accuracy of predicting influenza through various clinical and statistical models. Methodology A retrospective cross sectional analysis was done on demographic and epidemiological data collected from March 2009 to March 2010. Patients were classified as ILI or SARI using WHO case definitions. Respiratory specimens were tested by RT-PCR. Clinical symptoms and co-morbid conditions were analyzed using binary logistic regression models. Results In the first approach, analysis compared children (?12) and adults (>12). Of 1,243 cases, 262 (21%) tested positive for A(H1N1)pdm09 and the proportion of children (?12) and adults (>12) were 27% and 73% respectively. Four symptoms predicted influenza in children: fever (OR 2.849, 95% CI 1.931–8.722), cough (OR 1.99, 95% CI 1.512–3.643), diarrhea (OR 2.100, 95% CI 2.040–3.25) and respiratory disease (OR 3.269, 95% CI 2.128–12.624). In adults, the strongest clinical predictor was fever (OR 2.80, 95% CI 1.025–3.135) followed by cough (OR 1.431, 95% CI 1.032–2.815). In the second instance, patients were separated into two groups: SARI 326 (26%) and ILI 917 (74%) cases. Male to female ratio was 1.41?1.12 for SARI and 2?1.5 for ILI cases. Chi-square test showed that fever, cough and sore throat were significant factors for A(H1N1)pdm09 infections (p?=?0.008). Conclusion Studies in a primary care setting should be encouraged focused on patients with influenza-like illness to develop sensitive clinical case definition that will help to improve accuracy of detecting influenza infections. Formulation of a standard “one size fits all” case definition that best correlates with influenza infections can help guide decisions for additional diagnostic testing and also discourage unjustified antibiotic prescription and usage in clinical practice. PMID:24586575

Nisar, Nadia; Aamir, Uzma Bashir; Badar, Nazish; Mehmood, Muhammad Rashid; Alam, Muhammad Masroor; Kazi, Birjees Mazher; Zaidi, Syed Sohail Zahoor

2014-01-01