Influenciadores da desinformação nas pandemias de gripe espanhola e Covid-19: um estudo documental / Disinformation influencers in the spanish flu and covid-19 pandemics: a documentary study

Resumo: Introdução: Tão rápidas e destrutivas quanto a doença pandêmica,a propagação de inverdades em cenários de pandemias tem levado a muitas mortes. Para tanto, intervenções contrainfodêmicas são hoje um dos maiores desafios para o setor de saúde Objetivo: Este estudo teve como objetivo compreender as confluências da desinformação na gripe espanhola e na Covid-19 e como atuam os influenciadores de notícias falsas no campo da saúde brasileira. Método: Trata-se de estudo documental com abordagem qualitativa feita por meio da triangulação de dados em diferentes fontes e nos períodos da gripe espanhola (de 1918 a 1920) e da Covid-19 (de 2020 a 2021). Resultado: Observou-se que as pandemias foram e continuam cenários férteis para a produção e propagação dos influenciadores da desinformação e que se faz necessário problematizar os desafios da formação do trabalhador em tempos de modernidade líquida e em contextos de infodemias, já que os discursos profissionais têm sido fragilizados diante da desinformação. Conclusão: O estudo possibilitou compreender as confluências da desinformação entre a gripe espanhola e a Covid-19, e o papel da formação em saúde no enfrentamento da disseminação em massa de notícias falsas na saúde brasileira.

Abstract: Introduction: As fast and destructive as the pandemic disease is the spread of untruths in pandemic scenarios, which led to many deaths. Therefore, counter-infodemic interventions are currently one of the biggest challenges for the health sector. Objective: To understand the convergence of disinformation on the Spanish Flu and COVID-19 and how fake news influencers act in the Brazilian health field. Method: this is a documentary study with a qualitative approach, carried out through the triangulation of data from different sources and in the periods of the Spanish Influenza (1918 to 1920) and COVID-19 (2020 to 2021). Result: It was observed that the pandemics were and continue to be fertile scenarios for the production and dissemination of disinformation influencers and that it is necessary to problematize the challenges of worker training in times of liquid modernity and in contexts of infodemics, since the professional discourses have been weakened bydisinformation. Conclusion: the study allowed us to understand the convergence of disinformation between the Spanish Flu and COVID-19 and the role of health education when facing the mass dissemination of fake news in the Brazilian health field.

Lessons from the past in the present: news from the Spanish flu pandemic to COVID-19 / Lecciones del pasado en el presente: noticias de la pandemia de gripe española al COVID-19 / Lições do passado no presente: notícias da pandemia de gripe espanhola à Covid-19

ABSTRACT Objective: to analyze the health conducts for combating the Spanish flu and its relationship with the COVID-19 pandemic in Rio de Janeiro. Methods: study from the perspective of microhistory, with analysis of articles published in Revista da Semana on the Spanish flu, having as criteria publications with the term "epidemic" referring to the Spanish flu or influenza in the period of the epidemic outbreak in Rio de Janeiro, Federal District. Results: 18 records, organized in three thematic axes: political, 4; social, 11; care, 3, were found. Final considerations: the lessons left by the Spanish flu epidemic in coronavirus times will be changes in the political, social and care field as marks of major epidemics.

RESUMEN Objetivo: analizar la conducta sanitaria para combatir la gripe española y su relación con la pandemia COVID-19 en Río de Janeiro. Métodos: estudio desde la perspectiva de la microhistoria, con análisis de los artículos publicados en la Revista da Semana sobre la gripe española, utilizando como criterio las publicaciones con el término "epidemia" referida a la gripe española o influenza en el período de la epidemia y brote circunscrito en Río de Janeiro, Distrito Federal. Resultados: se encontraron 18 registros organizados en tres ejes temáticos: político, 4; social, 11; de atención, 3. Consideraciones finales: las lecciones dejadas por la epidemia de gripe española en tiempos de coronavirus serán los cambios en el ámbito político, social y asistencial como marcas de las grandes epidemias.

RESUMO Objetivo: analisar as condutas sanitárias para o combate da gripe espanhola e sua relação com a pandemia de COVID-19 no Rio de Janeiro. Métodos: estudo na perspectiva da micro-história, com análise de matérias publicadas na Revista da Semana sobre a gripe espanhola, tendo como critérios publicações com o termo "epidemia" referente à gripe espanhola ou à influenza no período do surto epidêmico e circunscrita no Rio de Janeiro, Distrito Federal. Resultados: foram encontrados 18 registros organizados em três eixos temáticos: político, 4; social, 11; de cuidados, 3. Considerações finais: as lições deixadas pela epidemia da gripe espanhola em tempos de coronavírus serão de mudanças no campo político, social e dos cuidados como marcas das grandes epidemias.

Expanding the pandemic influenza preparedness framework to the epidemic of COVID-19 / 中华预防医学杂志

On March 11, 2020, WHO officially declared that COVID-19 had become Pandemic. As of March 31, the epidemic had affected more than 178 countries and regions, with more than 780 000 confirmed cases. The Pandemic Influenza Preparedness Framework for the sharing of influenza viruses and access to vaccines and other benefits (the 'PIP Framework’ or 'Framework’) is an international arrangement adopted by the World Health Assembly (WHA) in May 2011 to improve global pandemic influenza preparedness and response. Since the transmission route and transmission capacity of COVID-19 are similar to that of influenza A (H1N1) in 2009, which conforms to the basic elements of 'human pandemic', and the epidemic scale has exceeded that of influenza A (H1N1). It is probable to incorporate COVID-19 epidemic response into PIPF, and at the same time to verify and improve PIPF in practice. It is recommended that WHO, other international organizations and relevant countries make full use of the PIPF system to respond to the epidemic and better coordinate national actions at the global level. At the same time, China should also make the planning and deploy of domestic epidemic prevention and control and international epidemic cooperation under the framework.

Mortalidad por Influenza pA(H1N1) 2009 en el noreste de México / Mortality from pandemic influenza A (H1N1) in northeast of Mexico

Objetivo. Determinar los factores asociados a la mortalidad por influenzapA(H1N1) en los pacientes hospitalizados por infección respiratoria agudagrave (IRAG) confirmada por reacción en cadena de la polimerasa (PCR)en el Instituto Mexicano del Seguro Social (IMSS).Material y métodos. En el IMSS en la delegación de Nuevo León entre el1 de junio de 2009 y 9 de marzo de 2010 se realizó un estudio observacionalretrospectivo de casos y controles, utilizando la base de datos del Sistemade Información en Línea para la Vigilancia Epidemiológica de Influenza(SINOLAVE). Se incluyeron 278 pacientes hospitalizados con IRAG (controles)y 50 pacientes con IRAG que fallecieron (casos) debido a la infecciónpor virus influenza pA(H1N1).Resultados. Los factores asociados a la mortalidad en los pacientes hospitalizadospor IRAG debida a influenza pA(H1N1) fueron la edad (OR: 1,03IC95% 1,01-1,05) y la obesidad (OR: 4,44 IC95% 1,85-1,6), utilizando unmodelo de regresión logística.Conclusión. Podemos concluir que en la delegación de Nuevo León delIMSS, la influenza pA(H1N1) afectó principalmente a adultos jóvenes, sinembargo las muertes se presentaron en mayor número en los pacientes alincrementar la edad y en pacientes con alguna comorbilidad.Palabras clave: Influenza pandémica A(H1N1), mortalidad, infección respiratoriaaguda grave, factores de riesgo, razón de probabilidad.

Objective. To determine factors associated with mortality from pAinfluenzA(H1N1) – confirmed by polymerase chain reaction (PCR) – Inhospitalized patients with severe acute respiratory infection (SARI) in theMexican Social Security Institute (IMSS). Methods. In the IMSS in the Delegation of Nuevo Leon between June 1, 2009 and March9, 2010 a retrospective observational case-control study was conducted using the database ofOnline Information System for Epidemiological Surveillance of Influenza (SINOLAVE). 278inpatients with SARI (controls) and 50 SARI patients who died (cases) due to infection withinfluenza virus pA(H1N1) were included.Results. In the logistic regression model factors associated with mortality in patientshospitalized due to SARI pA influenzA(H1N1) were age (OR: 1.03 95% CI 1.01-1.05) andobesity (OR: 4.44 95 1.85 to 1%, 0.6).Conclusion. We can conclude that the delegation of Nuevo León of the IMSS, pAinfluenzA(H1N1) affects mainly young adults, though the deaths occurred in greater numbersin patients with increasing age and in patients with comorbidities.

Pandemic influenza A (H1N1) 2009 in the English- and Dutch-speaking Caribbean an epidemiological overview / Pandemia de gripe A (H1N1) de 2009 en el Caribe de habla inglesa y holandesa: panorama epidemiológico

OBJECTIVE: To describe epidemiological trends of pandemic influenza A (H1N1) in the English- and Dutch-speaking Caribbean during the pandemic period. DESIGN AND METHODS: Data on laboratory-confirmed cases and deaths associated with pandemic influenza A (H1N1) contained in two regional databases at the Caribbean Epidemiology Centre (CAREC) were analysed. The data sources were epidemiological and laboratory reports from English- and Dutch-speaking countries and the CAREC laboratory information system (LABIS). RESULTS: In the English- and Dutch-speaking Caribbean, pandemic influenza A (H1N1) was the predominant circulating influenza virus type during the pandemic period. There were three distinct phases: a first pandemic wave during mid-April to end of August 2009 (734 cases), a second pandemic wave during September-December 2009 (570 cases) and a phase of low transmission during January to mid-August 2010 (55 cases). The majority of cases (76%) were aged less than 30 years, with children of school age being most affected. Most cases (89%) presented with symptoms of the respiratory tract and smaller proportions (20-40%) presented with gastrointestinal and other symptoms. No cases tested were resistant to oseltamivir. A quarter of cases required hospitalization and the case fatality rate was 1.8%. CONCLUSIONS: The epidemiological characteristics of the pandemic in the English- and Dutch-speaking Caribbean were consistent with that in other parts of the world. It is important that post pandemic surveillance (epidemiological and virological) for respiratory illnesses continues to be enhanced in order to give a better understanding of seasonality and changing trends in respiratory illnesses and their aetiologic agents.

OBJETIVO: Describir las tendencias epidemiológicas de la pandemia de gripe A (H1N1) en el Caribe de habla inglesa y holandesa durante el periodo pandémico. DISEÑO Y MÉTODOS: Se analizaron los datos sobre casos confirmados por laboratorio y muertes asociadas con la pandemia de gripe A (H1N1), contenidos en dos bases de datos regionales del Centro Epidemiológico del Caribe (CAREC). Las fuentes de los datos fueron los reportes epidemiológicos y de laboratorio de los países de habla inglesa y holandesa, así como del Sistema de Información de Laboratorio del CAREC (LABIS). RESULTADOS: En el Caribe anglófono y de habla holandesa, la pandemia de gripe A (H1N1) fue el tipo de virus de gripe que circuló predominante durante el periodo pandémico. Hubo tres fases distintas: una primera ola pandémica desde mediados de abril a finales de agosto de 2009 (734 casos); una segunda ola pandémica en septiembre-diciembre de 2009 (570 casos); y una fase de baja transmisión de enero a mediados de agosto de 2010 (55 casos). La mayoría de los casos (76%) tenían menos de 30 años, siendo los niños de edad escolar los más afectados. La mayor parte de los casos (89%) presentaban síntomas de las vías respiratorias, y un número menor (20-40%) presentaban síntomas gastrointestinales y otros síntomas. Ninguno de los casos sometidos a prueba resultó resistente al oseltamivir. Una cuarta parte de los casos requirió hospitalización, y la tasa de letalidad fue de 1.8%. CONCLUSIONES: Las características epidemiológicas de la pandemia en el Caribe de habla inglesa y holandesa concuerdan con las encontradas en otras partes del mundo. Es importante continuar mejorando la vigilancia postpandémica (epidemiológica y virológica) de las enfermedades respiratorias, con el fin de lograr una mejor comprensión de la estacionalidad y las tendencias cambiantes de las enfermedades respiratorias y sus agentes etiológicos.

Oseltamivir-resistant influenza A(H1N1) pdm09 virus: first reported case from India.

Background: Recent studies on antiviral susceptibiliy from South-East Asia, Europe and the United States have shown sporadic neuraminidase inhibitor (NAI) resistance in A(H1N1)pdm09 viruses. We undertook a study to evaluate NAI resistance in these viruses isolated in India. Methods: Pandemic influenza viruses, isolated from 2009 to 2013, along with clincal samples were genetically analysed for known resistance markers in the neuraminidase (NA) gene. Clinical samples (n=1524) were tested for H275Y (N1 numbering; H274Y in N2 numbering) mutation by real time reverse transcriptase PCR (rRT-PCR). One hundred and ten randomly selected resistant and sensitive viruses were analysed by phenotypic assay. Results: All but one of the 2013 A(H1N1)pdm09 isolates were sensitive to oseltamivir. Genetic analysis of this isolate as well as the original clinical material showed that the presence of H275Y mutation was responsible for reduced susceptibility to oseltamivir in the patient. This was confirmed by phenotypic assay. Conclusion: The emergence of a pandemic influenza strain resistant to oseltamivir emphasizes the need for monitoring antiviral resistance as part of the National Influenza Programme in India.

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

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 following 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. .

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

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 epidemiological 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. .

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

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. .

Clinical presentation of patients with seasonal influenza and pandemic influenza A (H1N1-2009) requiring hospitalisation.

Background. A sudden increase in the number of novel influenza A virus (pH1N1-2009) infection prompted us to compare the clinical presentation and outcomes of patients infected with pH1N1-2009 and seasonal influenza A virus during the postpandemic phase. Methods. During the period August 13 to September 27, 2010, case records of 106 patients with severe influenza like illness (ILI) and respiratory complications who underwent diagnostic testing by real-time polymerase chain reaction (RT-PCR) for confirmation of pH1N1-2009 were retrospectively studied. Results. Nineteen (17.9%) patients were tested positive for pH1N1-2009 and 78 (73.6%) were tested positive for seasonal influenza A virus. The mean age of patients infected with pH1N1-2009 was 45.2±15.3 years (range of 22 to 80 years). Common presenting symptoms included fever in 17 (89.4%), cough in 16 (84.2%), myalgia in 15 (78.9%) and breathlessness in 10 (52.6%) patients. The most common comorbidities included bronchial asthma/bronchitis/chronic obstructive pulmonary disease (COPD) in 4 (21%); followed by hypertension in 3 (15.8%) and diabetes in 3 (15.8%) patients. Overall, of the 97 influenza infected patients, 9 (9.3%) needed hospitalisation to the intensive care unit (ICU); one patient with COPD died due to multi-organ failure. Conclusions. Both the pandemic and seasonal strains were found to be co-circulating in the community. Patients with severe hypoxia, hypertension, acute respiratory distress syndrome and shock required ICU care.

Comparison of Immune Response by Virus Infection and Vaccination to 2009 Pandemic Influenza A/H1N1 in Children

We aimed to compare the immune response induced by natural infection with 2009 pandemic influenza A/H1N1 (pH1N1) virus and by monovalent pH1N1 vaccination in children and adolescents. This cross-sectional clinical study was conducted at 3 hospitals in Korea from February to May 2010. A total of 266 healthy subjects aged from 6 months to 18 yr were tested for the presence of the antibody against pH1N1 using hemagglutination inhibition (HI) test. Information about pH1N1 vaccination and laboratory-confirmed pH1N1 infection history was obtained. The overall rate of HI titers of > or = 1:40 against pH1N1 was 38.7%, and the geometric mean titer (GMT) was 20.5. Immunogenicity of pH1N1 vaccination only was reflected by a 41.1% of seroprotection rate and a GMT of 22.5. Immunogenicity of natural infection only was reflected by a 61.0% of seroprotection rate and a GMT of 40.0. GMT was significantly higher in the subjects of natural infection group than in the subjects of pH1N1 vaccination group (P < 0.001). The immune responses induced by natural pH1N1 infection exceed those induced by pH1N1 vaccinations.

An outbreak of pandemic influenza A (H1N1) in Kolkata, West Bengal, India, 2010.

Background & objectives: An increased number of cases with influenza like illness (ILI) were reported in Greater Kolkata Metropolitan Area (GKMA) during July and August 2010. We investigated these cases to confirm the outbreak, describe the distribution of patients and propose control measures. Methods: A suspected case of influenza like illness (ILI) was defined as acute onset of fever (>38°C) with cough or sore throat and a confirmed case as ILI case with throat swab positive for influenza A (H1N1) on RT-PCR. The demographic and clinical details were collected from patients attending the swine flu OPD of Infectious Disease Hospital, Kolkata, during July 5 to August 16, 2010. Results: Overall 440 patients with ILI attended the swine flu OPD of Infectious Disease and Bengal General hospital during the study period, of which 129 were positive for influenza A (H1N1). Four patients died (case fatality ratio: 0.90%). Besides fever, common symptoms included cough (73%), running nose (54%), sore throat (43%), respiratory distress (25%) and diarrhoea (4%). Forty seven (11%) patients (including the four who died) had co-morbidities. The outbreak started on July 10, peaked on July 24 and subsided by August 14, 2010. A total of 372 (85%) patients were from GKMA. Majority (n=168, 45%) of the cases from GKMA were from 6 boroughs of Kolkata Municipal Areas. Interpretation & conclusions: An outbreak of influenza A (H1N1) occurred in Kolkata predominantly affecting young and middle aged population. State health authorities implemented several interventions to limit the outbreak including training of health care providers in case management and infection control, vaccination of health care workers, creation of isolation wards and administration of oseltamivir to ILI patients, and community health education about social distance and personal hygiene measures.

Pandemic influenza A/H1N1 virus in a swine farm house in Sicily, Italy.

This report describes a pandemic A/H1N1 (H1N1 pdm) virus outbreak occurred in December, 2009 in a swine farm used as research facility (Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione) for preclinical studies, located in Sicily, Italy. All the 13 pigs of the farm, showed cough, fever, inappetence and weakness. At the same time, an unvaccinated worker of the stabling showed influenza-like symptoms. RNAv extracted from two swabs collected from infected pigs resulted positive by Real Time RT-PCR for Influenza A virus. Furthermore, after growth on embryonated eggs, viral isolates were identified by Real Time RT-PCR specific for H1N1 pdm virus and characterized antigenically. Sequencing of the whole genome was also performed. All sera taken from animals and from the worker were tested by a competitive Influenza A ELISA and by the haemoagglutination inhibition test. Serological findings confirmed the circulation of influenza virus H1N1 pdm in pigs and the presence of specific antibodies against H1N1 pdm in human serum. The results of this study seem to support a H1N1 pdm transmission from man to animals showing the importance of serological and virological investigation to control the pig farms and the importance of close cooperation between the different authorities like veterinarian and human public.

Epidemiological Characteristics of Imported Influenza A (H1N1) Cases during the 2009 Pandemic in Korea / 한국역학회지

OBJECTIVES: Quarantine measure for prevention of epidemic disease and further evaluations of their efficiency are possible only by elaborating analyses of imported cases. The purpose of this study was to analyze descriptive epidemiological characteristics of pandemic influenza A (H1N1) cases imported to Korea. METHODS: We collected two sets of data. The first set, comprised daily reported cases of H1N1 obtained from local cities in accordance with government policy about mandatory reporting of all H1N1 cases during May 1 to August 19, 2009. The second set, including 372 confirmed imported H1N1 cases, identified from 13 National Quarantine Stations in the Korea Centers for Disease Control and Prevention from May 24 to December 31, 2009. However, given the lack of information on the nature of the imported H1N1 cases from the two data sets during the over lapping period from May 24 to August 19, we express the number of imported cases as a range for this period. RESULTS: We estimated that the number of imported H1N1 cases from May 1 to August 19, 2009, was between 1,098 and 1,291 and the total number of cases was 2,409 to 2,580. We found the number of imported cases was beginning to diminish as of August. A analysis of the second data set showed that the distribution of sex was similar (males 50.7%, females 49.3%) and the age distribution from 20 to 59 was 61.5% and that of 60 and over was 0.8% of the 372 cases. We identified 25 countries where people infected with H1N1 traveled and 67.5% were in Asia. But the proportion of cases (/1,000) by region shows Oceania (0.199), South America (0.118), Southeast Asia (0.071), North America (0.049), Europe (0.035), and Northeast Asia (0.016) in that order. The order of H1N1 peaking was the Southern Hemisphere, Tropics, and the Nothern Hemisphere. CONCLUSIONS: This study provided information that could make possible the evaluation of the government quarantine measure for stopping imported disease from causing community-acquired spread in the future.

2009 Pandemic Influenza A(H1N1) Infections in the Pediatric Cancer Patients and Comparative Analysis with Seasonal Influenza / 소아감염

PURPOSE: This study was performed to compare the clinical characteristics of 2009 pandemic influenza A(H1N1) [A(H1N1) pdm09] and seasonal influenza A infection in the pediatric cancer patients. METHODS: A retrospective review was performed in the pediatric cancer patients who had confirmed A(H1N1)pdm09 infection at Samsung Medical Center from August 2009 to February 2010. For the comparison, the medical records of pediatric cancer patients with seasonal influenza A from January 2000 to May 2009 were reviewed retrospectively. RESULTS: Eighty-two A(H1N1)pdm09 infections were confirmed in the pediatric cancer patients. Ten patients (12.2%) developed complicated clinical course by lower respiratory infections or extrapulmonary infections; 4 pneumonia, 1 bronchitis, 1 pericarditis with pneumonia, 1 encephalitis with pneumonia, 2 meningitis and 1 pericarditis. Three patients received mechanical ventilator and ICU care. Three pediatric cancer patients (3.7%) died. The risk factors related to complicated A(H1N1)pdm09 infections were date of infection (44-45th week 2009) and nosocomial infection. When comparing with previous seasonal influenza A infections, more prompt and aggressive antiviral therapy was given in A(H1N1)pdm09 infections. CONCLUSION: The A(H1N1)pdm09 infections caused a various clinical manifestations including fatal cases in pediatric cancer patient during pandemic season. There was no significant difference in clinical course between influenza A(H1N1)pdm09 and seasonal influenza A infections except the antiviral treatment strategy.

Characteristics of Hospitalized Children with 2009 Pandemic Influenza A (H1N1): A Multicenter Study in Korea

The majority of Korean patients with pandemic influenza A (H1N1) during the 2009 epidemic were under 20 yr of age. The limited data on the clinical characteristics of these children led us to conduct a case note-based investigation of children admitted to 6 university hospitals with 2009 H1N1 influenza. A total of 804 children was enrolled. The median age was 5 yr; 63.8% were males; and 22.4% had at least one chronic underlying disease. Ninety-five of the patients (11.8%) were critically ill and they suffered more from shortness of breath, dyspnea and lymphopenia than the other patients. Among all the patients, 98.8% were treated with antivirals and 73% received treatment within 48 hr of illness onset. All the enrolled patients are alive and appear to have had good outcomes, probably due to the early intervention and antiviral treatment. This study deals with hospitalized children whose diagnoses of influenza A (H1N1) were confirmed, and therefore provides important new information about the clinical patterns of children with influenza A (H1N1) in Korea.

Clinical and Laboratory Characteristics of Pandemic Influenza A/H1N1 2009 Infection among Patients with Malignancy in Korea / 감염과화학요법

BACKGROUND: Patients with malignancy are considered to be at high risk of severe pandemic influenza A/H1N1 2009. This study was conducted to identify the severity of pandemic influenza A/H1N1 2009 among patients with malignancy. MATERIALS AND METHODS: Between August 2009 and December 2009, we reviewed clinical data and medical records of 31 patients with malignancy and 63 hospitalized patients without malignancy. RESULTS: Eighty-three patients with laboratory-confirmed pandemic influenza A/H1N1 2009 were admitted. The rate of ICU admission was higher among patients with malignancy (without malignancy 13% vs with malignancy 35%, P=0.024). The mortality rate was higher among patients with malignancy (without malignancy 6% vs with malignancy 25%, P=0.033). Patients using immunosuppressants showed a higher rate of lower respiratory tract infection (83% vs 24%, P=0.013). CONCLUSIONS: Pandemic influenza A/H1N1 2009 in patients with malignancy was more severe than in patients without malignancy.

Isolation and characterization of a pandemic H1N1 influenza virus in pigs in Brazil / Isolamento e caracterização do vírus da influenza pandêmico H1N1 em suínos no Brasil

Influenza A virus (IAV) infections are endemic in pork producing countries around the world. The emergence of the pandemic 2009 human H1N1 influenza A virus (pH1N1) raised questions about the occurrence of this virus in Brazilian swine population. During a 2009-2010 swine influenza virus research project at Embrapa Swine and Poultry (CNPSA), an outbreak of a highly transmissible H1N1 influenza A virus disease was detected in a pig herd in Santa Catarina State, Brazil. The virus caused a mild disease in growing pigs and sows without mortality. Three clinically affected piglets were euthanized. Gross lesions included mild to moderate consolidation of cranioventral areas of the lung. Microscopically, the lesions were characterized by necrotizing obliterative bronchiolitis and bronchointerstitial pneumonia. Immunohistochemistry using a monoclonal antibody against type A influenza virus nucleoprotein revealed positive staining in the nuclei of the bronchiolar epithelial cells. Lung tissue from three piglets and nasal swabs from five sows and four piglets were positive for influenza A by RT-PCR. Influenza virus was isolated from one lung, later confirmed by the hemagglutination test (HA titer 1:128) and RT-PCR. Sequence analyses of Hemmaglutinin (HA) and Matrix (M) genes revealed that the virus was consistent with the pandemic (A/H1N1) 2009 influenza virus strain that circulated in humans. This is the first report of an outbreak of pandemic A/H1N1 influenza virus in pigs in Brazil.

A infecção causada pelo vírus Influenza A (IAV) é endêmica em suínos no mundo inteiro. O surgimento da pandemia de influenza humana pelo vírus A/H1N1 (pH1N1) em 2009 levantou dúvidas sobre a ocorrência deste vírus em suínos no Brasil. Durante o desenvolvimento de um projeto de pesquisa do vírus de influenza suína em 2009-2010, na Embrapa Suínos e Aves (CNPSA), foi detectado em um rebanho de suínos em Santa Catarina, Brasil, um surto de influenza altamente transmissível causado pelo subtipo viral H1N1. Este vírus causou uma doença leve em suínos em crescimento e em fêmeas adultas, sem mortalidade. Tres leitões clinicamente afetados foram eutanasiados. As lesões macroscópicas incluiam consolidação leve a moderada das áreas cranioventrais do pulmão. Microscopicamente, as lesões foram caracterizadas por bronquiolite necrosante obliterativa e pneumonia broncointersticial. A imunohistoquímica, utilizando um anticorpo monoclonal contra a nucleoproteína do vírus influenza A, revelou marcação positiva no núcleo das células epiteliais bronquiolares. O tecido pulmonar de três leitões e os suabes nasais de cinco fêmeas e quatro leitões foram positivos para influenza A pela RT-PCR. O vírus influenza foi isolado de um pulmão, mais tarde sendo confirmado pelo teste de hemaglutinação (título HA 1:128) e por RT-PCR. A análise das seqüências de nucleotídeos dos genes da hemaglutinina (HA) e proteína da matriz (M) revelou que o vírus isolado foi consistente com o vírus pandêmico A/H1N1/2009 que circulou em humanos no mesmo período. Este é o primeiro relato de um surto de influenza causado pelo vírus pandêmico A/H1N1 em suínos no Brasil.

Demand for care and nosocomial infection rate during the first influenza AH1N1 2009 virus outbreak at a referral hospital in Mexico City / Demanda asistencial y tasa de infección nosocomial durante el primer brote de influenza AH1N1 2009 en un hospital de referencia en la Ciudad de México

OBJECTIVE: Comparison of routine hospital indicators (consults at the Emergency Room (ER) and hospital admissions) during the 2009 pandemic of the influenza AH1N1 virus at the national referral hospital for respiratory diseases in Mexico City. MATERIAL AND METHODS: The outbreak was from April to mid-May 2009 and two control periods were used:2009 (before and after the outbreak),and during April-May from 2007 and 2008. RESULTS: During the outbreak total consultation at the ER increased six times compared with the 2007-2008 control period and 11 times compared with the 2009 control period. Pneumonia- or influenza-related ER consultations increased 23.2 and 15.3 percent, respectively. The rate of nosocomial infection during the outbreak was 13.6 and that of nosocomial pneumonia was 6 per/100 hospital discharges, a two-fold and three-fold increase compared to the control periods respectively. CONCLUSIONS: During the outbreak,mean severity of admitted patients increased,with a rise in in-hospital mortality and nosocomial infections rate, including nosocomial pneumonia.

OBJETIVO: Comparación de indicadores hospitalarios de rutina (consultas de urgencia, admisiones hospitalarias etc.) durante la pandemia de influenzaAH1N1 2009 en un hospital de referencia para enfermedades respiratorias de la Ciudad de México. MATERIAL Y MÉTODOS: El brote se consideró de abril a la mitad de mayo de 2009 y se comparó con dos periodos control: el de 2009 (antes y después del brote), y durante abril y mayo de 2007 y 2008. RESULTADOS: Durante el brote las consultas de urgencia crecieron seis veces comparadas con el periodo control 2007-2008 y 11 veces contra el periodo control de 2009. Las consultas por neumonía o influenza incrementaron 23.2 y 15.3 por ciento comparadas contra los periodos control, respectivamente. La tasa de infección nosocomial durante el brote fue de 13.6 y la de neumonía nosocomial de 6.0 por 100 egresos hospitalarios, el doble y el triple de la documentada en los periodos control respectivamente. CONCLUSIONES: Durante el brote, la gravedad promedio de los pacientes hospitalizados se incrementó, desencadenando un aumento en la mortalidad hospitalaria y en la tasa de infecciones nosocomiales, incluyendo la de neumonía nosocomial.

Clinical Profile and Outcome of Swine Flu in Indian Children.

Objective: To describe the clinical characteristics and outcome of Indian children infected with 2009 H1N1 influenza virus. Study design: Retrospective chart review. Setting: Outpatient department and hospitalized patients in a tertiary care hospital. Methods: Clinical details of 85 children (positive for the 2009 H1N1 virus infection tested by real-time reversetranscriptase– polymerase-chain-reaction assay) were analyzed from medical charts. Results: Of the 85 (55 boys) children positive for 2009 H1N1 virus infection, 64.7% were between 5 years to 16 years, and 35.3% were below 5 years age. The mean age of these children was 7.5±3.5 yr. Contact history was positive only in 22 (26%) cases. High grade fever was the most common symptom, followed by cough and rhinorrhea. Twenty-nine (34%) patients had an underlying co-morbid condition. Of the 34 patients who underwent chest radiography during evaluation, 18 children (52.9%) had findings consistent with lower respiratory tract infection. Antiviral therapy was initiated in 76 patients. Hospitalization was required in 30 (35.3%) children. Risk factors for hospitalization included underlying co-morbid condition, respiratory distress, vomiting, wheezing, diarrhea, hypotension and infiltrates/consolidation on chest radiograph. Mean length of hospitalization was 131+76 hours, irrespective of underlying disease. Three children developed Acute Respiratory Distress Syndrome and died. Conclusions: Clinical features and routine laboratory investigations in children with swine origin influenza were non-specific. Children with co-morbid condition, respiratory distress, vomiting, wheezing, diarrhea, hypotension and infiltrates/consolidation on chest radiograph were at higher risk of hospitalization.