Machine learning in predicting severe acute respiratory infection outbreaks / Aprendizado de máquina na previsão de surtos de síndrome respiratória aguda grave / Aprendizaje automático en la predicción de brotes de síndrome respiratorio agudo grave

Abstract: Severe acute respiratory infection (SARI) outbreaks occur annually, with seasonal peaks varying among geographic regions. Case notification is important to prepare healthcare networks for patient attendance and hospitalization. Thus, health managers need adequate resource planning tools for SARI seasons. This study aims to predict SARI outbreaks based on models generated with machine learning using SARI hospitalization notification data. In this study, data from the reporting of SARI hospitalization cases in Brazil from 2013 to 2020 were used, excluding SARI cases caused by COVID-19. These data were prepared to feed a neural network configured to generate predictive models for time series. The neural network was implemented with a pipeline tool. Models were generated for the five Brazilian regions and validated for different years of SARI outbreaks. By using neural networks, it was possible to generate predictive models for SARI peaks, volume of cases per season, and for the beginning of the pre-epidemic period, with good weekly incidence correlation (R2 = 0.97; 95%CI: 0.95-0.98, for the 2019 season in the Southeastern Brazil). The predictive models achieved a good prediction of the volume of reported cases of SARI; accordingly, 9,936 cases were observed in 2019 in Southern Brazil, and the prediction made by the models showed a median of 9,405 (95%CI: 9,105-9,738). The identification of the period of occurrence of a SARI outbreak is possible using predictive models generated with neural networks and algorithms that employ time series.

Resumo: Surtos de síndrome respiratória aguda grave (SRAG) ocorrem anualmente, com picos sazonais variando entre regiões geográficas. A notificação dos casos é importante para preparar as redes de atenção à saúde para o atendimento e internação dos pacientes. Portanto, os gestores de saúde precisam ter ferramentas adequadas de planejamento de recursos para as temporadas de SRAG. Este estudo tem como objetivo prever surtos de SRAG com base em modelos gerados com aprendizado de máquina usando dados de internação por SRAG. Foram incluídos dados sobre casos de hospitalização por SRAG no Brasil de 2013 a 2020, excluindo os casos causados pela COVID-19. Estes dados foram preparados para alimentar uma rede neural configurada para gerar modelos preditivos para séries temporais. A rede neural foi implementada com uma ferramenta de pipeline. Os modelos foram gerados para as cinco regiões brasileiras e validados para diferentes anos de surtos de SRAG. Com o uso de redes neurais, foi possível gerar modelos preditivos para picos de SRAG, volume de casos por temporada e para o início do período pré-epidêmico, com boa correlação de incidência semanal (R2 = 0,97; IC95%: 0,95-0,98, para a temporada de 2019 na Região Sudeste). Os modelos preditivos obtiveram uma boa previsão do volume de casos notificados de SRAG; dessa forma, foram observados 9.936 casos em 2019 na Região Sul, e a previsão feita pelos modelos mostrou uma mediana de 9.405 (IC95%: 9.105-9.738). A identificação do período de ocorrência de um surto de SRAG é possível por meio de modelos preditivos gerados com o uso de redes neurais e algoritmos que aplicam séries temporais.

Resumen: Brotes de síndrome respiratorio agudo grave (SRAG) ocurren todos los años, con picos estacionales que varían entre regiones geográficas. La notificación de los casos es importante para preparar las redes de atención a la salud para el cuidado y hospitalización de los pacientes. Por lo tanto, los gestores de salud deben tener herramientas adecuadas de planificación de recursos para las temporadas de SRAG. Este estudio tiene el objetivo de predecir brotes de SRAG con base en modelos generados con aprendizaje automático utilizando datos de hospitalización por SRAG. Se incluyeron datos sobre casos de hospitalización por SRAG en Brasil desde 2013 hasta 2020, salvo los casos causados por la COVID-19. Se prepararon estos datos para alimentar una red neural configurada para generar modelos predictivos para series temporales. Se implementó la red neural con una herramienta de canalización. Se generaron los modelos para las cinco regiones brasileñas y se validaron para diferentes años de brotes de SRAG. Con el uso de redes neurales, se pudo generar modelos predictivos para los picos de SRAG, el volumen de casos por temporada y para el inicio del periodo pre-epidémico, con una buena correlación de incidencia semanal (R2 = 0,97; IC95%: 0,95-0,98, para la temporada de 2019 en la Región Sudeste). Los modelos predictivos tuvieron una buena predicción del volumen de casos notificados de SRAG; así, se observaron 9.936 casos en 2019 en la Región Sur, y la predicción de los modelos mostró una mediana de 9.405 (IC95%: 9.105-9.738). La identificación del periodo de ocurrencia de un brote de SRAG es posible a través de modelos predictivos generados con el uso de redes neurales y algoritmos que aplican series temporales.

Investigation of viral etiology with sever acute respiratory infection of hospitalized patients in Guangdong Province from 2019 to 2021 / 公共卫生与预防医学

Objective To investigate the infection status and epidemiological characteristics of viral pathogens in hospitalized patients with severe acute respiratory infection (SARI) in Guangdong Province from 2019 to 2021, so as to provide reference for clinical diagnosis and prevention. Methods The respiratory tract samples of SARI patients collected from 2019 to 2021 were detected and analyzed for respiratory syncytial virus (RSV), adenovirus (ADV), human rhinovirus/enterovirus (HRV/EV), human metapneumonic virus (HMPV) and other common respiratory viruses using Luminex respiratory multi-pathogen detection technology. Results A total of 1 948 influenza-negative cases were collected, of which 24.28 % were positive detection of virus infection. HRV/EV was the highest (10.32%), followed by RSV (4.31%). The detection rates were statistically significantly different among different age groups (χ2=176.186，P2=0.042，P>0.05). The detection peaks of RSV were mainly concentrated in summer and autumn, while HMPV was prevalent in winter, and HRV/EV and ADV had no obvious seasonality. Mixed infection was found in 39 samples, and the mixed infection rate was 2.00%. In the mixed infection cases, HPIV and HRV/EV combined infection was the most common. Conclusion HRV/EV, RSV, HMPV and ADV are predominant viral pathogens in SARI influenza-negative hospitalized cases in Guangdong Province from 2019 to 2021. It is recommended to strengthen the surveillance of SARI cases in children under 5 years old.

Clinical Profile of COVID-19 Illness in Children—Experience from a Tertiary Care Hospital

Objective To detail clinical profle and outcome in children infected with SARS-CoV-2. Methods This retrospective study was undertaken at a tertiary care pediatric teaching hospital in Northern India. The data on clinical characteristics and outcome of children (<18 y) with COVID-19 illness from April 2020–October 2020 were reviewed and analyzed. Results A total of 2919 children with suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) illness were tested for novel COVID-19 virus in the fu emergency (n=1744), severe acute respiratory infection (SARI) ward (n=825), and non-COVID area (n=350) of the hospital. 8.73% (255/2919) children tested positive for SARS-CoV-2 infection. Of the 255 positive cases, 144 (56.47%) were managed on an outpatient basis and 100 (59 boys) required admission in COVID ward. The mortality rate of patients with SARS-CoV-2 was 11.4% (29/255). Majority of children admitted with COVID-19 had severe to critical illness due to the presence of malnutrition and underlying comorbidities. Conclusions Children of all age groups were susceptible to COVID-19 illness with a slight male preponderance. Amongst infected, two-third were asymptomatic or had mild symptoms that required outpatient management and home isolation. The adverse outcomes were more commonly seen in infants and children>10 y of age with malnutrition and comorbid illness.

Fatores associados à Síndrome Respiratória Aguda Grave em uma Região Central do Brasil / Factors associated with Severe Acute Respiratory Syndrome in a Brazilian central region

Resumo A Síndrome Respiratória Aguda Grave (SRAG) deve ser notificada e investigada. O objetivo do estudo foi analisar o perfil epidemiológico e fatores associados à internação e óbitos por SRAG notificados em Goiás. Estudo de coorte retrospectiva, com dados das fichas de investigação do Sistema de Informação de Agravos de Notificação Influenza Web. Métodos de análise multivariada foram realizados para verificar a associação entre variáveis de exposição com os desfechos internação em UTI e óbito. Entre 2013 e 2018 foram notificados 4.832 casos de SRAG em Goiás. O principal diagnóstico etiológico foi influenza A (22,3%) com o subtipo A (H1N1pdm09) predominante, seguido pelo Vírus Sincicial Respiratório. 34,6% dos pacientes necessitaram de internação em UTI e 19% evoluíram para o óbito. Maior tempo de início do tratamento com antiviral foi associado à maior chance de internação em UTI, enquanto a não vacinação prévia contra a influenza, maior tempo para início do antiviral e idade mais avançada foram associados à maior chance de óbito. O estudo mostrou uma elevada frequência de doenças respiratórias provocadas pelo vírus Influenza no estado de Goiás e que a gravidade da síndrome, caracterizada pela internação em UTI e óbitos, está associada com o tempo de início do tratamento com o antiviral, o status vacinal e a idade do paciente.

Abstract Severe Acute Respiratory Infection (SARI) is a notifiable syndrome that must be investigated. This study aimed to analyze the epidemiological profile and factors associated with SARI-related hospitalization and deaths reported in Goiás. Retrospective cohort study, with data from the investigation files of the Notifiable Diseases Information System's Influenza Web. Multivariate analysis methods were employed to verify the association between exposure variables with the outcomes of ICU admission and death. A total of 4,832 SARI cases were reported in Goiás from 2013 to 2018. The primary etiological diagnosis was Influenza A (22.3%) with the predominant subtype A (H1N1pdm09), followed by the Respiratory Syncytial Virus. A total of 34.6% of the patients required ICU admission, and 19% died. A longer time to start treatment with antivirals was associated with a higher likelihood to have an ICU admission, while a previous non-vaccination against Influenza, longer time to start treatment, and older age were associated with a higher likelihood to suffer death. The study showed a high frequency of respiratory diseases caused by the Influenza virus in Goiás and that the severity of the syndrome, characterized by ICU admission and deaths, is associated with the start of antiviral treatment vaccine status, and patient's age.

Novel Coronavirus Pneumonia Outbreak in 2019: Computed Tomographic Findings in Two Cases

Since the 2019 novel coronavirus (2019-nCoV or officially named by the World Health Organization as COVID-19) outbreak in Wuhan, Hubei Province, China in 2019, there have been a few reports of its imaging findings. Here, we report two confirmed cases of 2019-nCoV pneumonia with chest computed tomography findings of multiple regions of patchy consolidation and ground-glass opacities in both lungs. These findings were characteristically located along the bronchial bundle or subpleural lungs.

Pathogenic characteristics of hospitalized severe acute respiratory infections in Shanghai, China, 2015-2017 / 中华流行病学杂志

Objective@#To understand the epidemiological and pathogenic characteristics of hospitalized severe acute respiratory infections (SARI) in Shanghai, China.@*Methods@#From 2015 to 2017, one Tertiary hospital and one Secondary hospital were chosen as the surveillance sites. Two respiratory tract specimens per case were collected from SARI cases aged 15 years and older. One specimen was tested for 22 respiratory pathogens by RT-PCR, and the other specimen was cultured for 6 respiratory bacteria.@*Results@#A total of 287 SARI cases were enrolled for sampling and lab testing. 70.73% of the cases were aged 60 years and older, with 41.46% (119/287) were positive for at least one pathogen. Influenza virus was the predominant pathogen, accounting for 17.77% (51/287) of all SARI cases. Human rhinovirus/Enterovirus and Coronavirus were both accounting for 7.32% (21/287), followed by Mycoplasma pneumoniae (5.57%, 16/287). The positive rates of parainfluenza virus, bocavirus, adenovirus, respiratory syncytial virus and human metapneumo virus were all less than 5%. Bacterial strains were identified in seven SARI cases, including Klebsiella pneumoniae (3 strains), Staphylococcus aureus (2 strains), Streptococcus pneumoniae (1 strain) and Pseudomonas aeruginosa (1 strain). Two or Three pathogens were co-detected from 40 cases, accounting for 33.61% of 119 positive cases. The most common co-detected pathogens were influenza virus and Mycoplasma pneumoniae (10 cases). Influenza cases peaked in winter-spring and summer. Mycoplasma pneumoniae peaked in winter-spring season and overlapped with influenza. The positive rates of pathogens were not significantly different between different age groups.@*Conclusions@#Various respiratory pathogens can be detected from SARI cases aged 15 years and older. Influenza virus was the predominant pathogen and the co-detection of influenza virus with Mycoplasma pneumoniae the most common one.

Viral detection profile in children with severe acute respiratory infection

ABSTRACT Objectives: The role of viral co-detection in children with severe acute respiratory infection is not clear. We described the viral detection profile and its association with clinical characteristics in children admitted to the Pediatric Intensive Care Unit (PICU) during the 2009 influenza A(H1N1) pandemic. Method: Longitudinal observational retrospective study, with patients aged 0-18 years, admitted to 11 PICUs in Rio de Janeiro, with suspected H1N1 infection, from June to November, 2009. The results of respiratory samples which were sent to the Laboratory of Fiocruz/RJ and clinical data extracted from specific forms were analyzed. Results: Of 71 samples, 38% tested positive for H1N1 virus. Of the 63 samples tested for other viruses, 58 were positive: influenza H1N1 (43.1% of positive samples), rhinovirus/enterovirus (41.4%), respiratory syncytial vírus (12.1%), human metapneumovirus (12.1%), adenovirus (6.9%), and bocavirus (3.5%). Viral codetection occured in 22.4% of the cases. H1N1-positive patients were of a higher median age, had higher frequency of fever, cough and tachypnea, and decreased leukometry when compared to H1N1-negative patients. There was no difference in relation to severity outcomes (number of organic dysfunctions, use of mechanical ventilation or amines, hospital/PICU length of stay or death). Comparing the groups with mono-detection and co-dection of any virus, no difference was found regarding the association with any clinical variable. Conclusions: Other viruses can be implicated in SARI in children. The role of viral codetection has not yet been completely elucidated.

Hospitalization costs due to severe acute respiratory infection (SARI) in three Central American countries / Costos de hospitalización de infección respiratoria aguda grave (IRAG) en tres países de América Central

Objective: To estimate the direct medical costs of severe acute respiratory infection (SARI) in children and adults from three Central American countries with a bottom-up costing approach. Methods: The costs of inpatients treatment were estimated through the retrospective bottom-up costing in a randomized sample of clinical records from SARI patients treated in teaching tertiary hospitals during 2009 - 2011 period. Activities incurred per patient were registered and a setting-specific cost per activity was acquired. Average cost per patient in the group of children and elderly adults was estimated for each country. In Nicaragua, only the pediatric population was included. Costs were expressed in local currency (2011), American dollars, and international dollars (2005) for country comparison. Results: The care cost per case in children in Guatemala was the cheaper (I$971.95) compared to Nicaragua (I$1,431.96) and Honduras (I$1,761.29). In adults, the treatment cost for Guatemala was the more expensive: I$4,065.00 vs. I$2,707.91 in Honduras. Conclusion: Bottom-up costing of SARI cases allowed the mean estimates per treated case that could have external validity for the target population diagnosed in hospitals with similar epidemiological profiles and level of complexity for the study countries. This information is very relevant for the decision-making.

Objetivo: Estimar los costos directos de la atención de infección respiratoria aguda (IRAG) en niños y adultos en tres países de América Central. Métodos: Los costos de pacientes hospitalizados fueron estimados a través de análisis retrospectivo en una muestra aleatoria de registros de historias clínicas de casos de IRAG tratado en hospitales universitarios durante el periodo 2009-2011. Las actividades incurridas por paciente fueron registradas y un costo especifico para cada sitio fue estimado. El costo por cada niño y adulto mayor fue estimado para cada país. En Nicaragua sólo se incluyó población pediátrica. Los costos fueron expresados en moneda local (2011), dolar americano y dolar internacional (2005). Resultados: El costo por caso en niños en Guatemala fue el más barato (I$971.95) comparado al de Nicaragua (I$1,431.96) y Honduras (I$1,761.29). En adultos, el costo de tratamiento para Guatemala fue el más costoso: I$4,065.00 vs. I$2,707.91 en Honduras. Conclusión: Los costos de tratar casos IRAG estimados a partir de costos promedios pro caso pueden tener validez externa para hospitales con perfiles epidemiologicos similares y nivel de complejidad de atención para los países del estudio. Esta información es muy relevante para la toma de decisiones.

Serotypes of human rhinoviruses isolated from hospitalized children with severe acute respiratory in-fection in Shanghai during the autumn and winter of 2016-2017 / 中华微生物学和免疫学杂志

Objective To investigate the etiological characteristics of common viral respiratory tract infections and to analyze the distribution of human rhinovirus(HRV) serotypes in children with severe acute respiratory tract infection (SARI) in Shanghai. Methods Totally 199 nasopharyngeal aspirate speci-mens were collected from children with SARI in Shanghai from October 2016 to March 2017. A nuclear acid test was performed to detect 15 common respiratory viruses in these specimens. HRV strains were screened out using the primer pairs derived from the 5′UTR of HRV and the serotypes of them were identified based on the VP4-VP2 gene sequencing. Results Among the 199 specimens,HRV-positive specimens accounted for 26.1%,followed by those positive for influenza A(6.5%),adenovirus(6.5%),respiratory syncytial vi-rus(6.5%) and Boca virus(5%). Fifty-two HRV-positive specimens were typed by the VP4-VP2 gene se-quencing with 30 belonging to species A(18 serotypes,predominant serotypes:A21,A12,A38,A78,A88 and A96),seven belonging to species B (five serotypes, predominant serotype: B72) and 15 belonging to species C (nine serotypes,predominant serotypes:C27 and C40). There were two cases of HRV co-infec-tion. Two HRV-positive specimens could not be typed. HRV mixed serotype infections and co-infections of HRV with other viruses were existed. No significant difference in infection rates of different age groups and clinical characteristics was found between HRV-A and HRV-C infection groups. Conclusion HRV-A and HRV-C were the predominant pathogens causing SARI in children in Shanghai. Thirty-two HRV serotypes were detected and the predominant types were A21,A12,A38,A78,A88,A96,B72,C27 and C40.

Epidemiological characteristics and genetic evolution of human bocavirus infection in hospitalized children with severe acute respiratory infection in Hangzhou / 中华临床感染病杂志

Objective To study the epidemiological characteristics and genetic evolution of human bocavirus ( HBoV ) infection in hospitalized children with severe acute respiratory infection ( SARI ) in Hangzhou.Methods A total of 1388 clinical specimens were collected from children with SARI admitted in Affiliated Children' s Hospital, Zhejiang University School of Medicine from January 2011 to December 2014.HBoV1-4 and other respiratory pathogens were identified by fluorescent real -time polymerase chain reaction (fRT-PCR).The VP1 gene in HBoV1 positive samples was amplified and sequenced for genetic analysis with Clustal X and MEGA 6.0.Chi-square test and Fisher exact probability were used to analyze the data.Results Eighty five HBoV positive samples were detected from 1388 samples (6.12％), among which 83 (97.65％) were HBoV1 positive and 2 (2.35％) were HBoV2 positive.The positive rates of HBoV in males and females were 6.54％and 5.35％(χ2 =0.780, P>0.05).The posititve detection rate of HBoV in all age groups was statistically significant (χ2 =47.446,P <0.01).The detection rate in children aged 6 months-1 year was highest (12.84％), in children aged >3 years was lowest (1.64％), in children aged ≤6 months and aged 1-3 years was 3.04％ and 3.33％, respectively.The detection rate of HBoV in summer was the highest (14.97％), followed by that in autumn (7.14％), spring (3.19％) and winter (1.97％) (χ2 =58.807, P<0.01).The detection rates of HBoV in 2011 to 2014 were 7.39％, 7.31％, 5.58％ and 4.72％ (χ2 =3.447, P >0.05 ).The co-infection rate with other respiratory pathogens was 62.35％.The main pathogens were human rhinovirus (33.96％), parainfluenza virus (28.30％) and respiratory syncytial virus (20.75％).The incidence of anhelation and wheezing in HBoV positive group was higher than that in HBoV negative group (χ2 =15.161 and 13.914, P <0.01). Sequence analysis of VP 1 gene showed that 44 isolates belonged to the same branch ( clade 1 ) as Swedish strain ST2, and 2 isolates HZ12-S32 and HZ12-S199 belonged to a separated branch.Conclusion HBoV is an important causative agent of hospitalized children with SARI in Hangzhou area and has high co -infection with other respiratory pathogens.Most of the strains belong to the same clade as the Swedish strain ST 2, and two strains of HZ12-S32 and HZ12-S199 are identified in a separated clade.

Costos de tratamiento hospitalario de la infección respiratoria aguda grave en niños de Nicaragua / Cost of treatment for severe acute respiratory infection in Nicaraguan children

Objetivo: Estimar los costos de tratamiento hospitalario de la infección respiratoria aguda grave (IRAG) en niños en Nicaragua. Métodos: Se estimaron costos de tratamiento de pacientes hospitalizados a partir del microcosteo retrospectivo de una muestra aleatoria de casos ocurridos durante el periodo 2009-2011 en Nicaragua y atendidos en un hospital pediátrico universitario de alta complejidad. Se calculó una muestra aleatoria de pacientes con diagnósticos de IRAG (CIE-10), según parámetros extraídos de la literatura. En esta, se estimó el costo promedio por paciente. Los costos fueron expresados en moneda local de 2011 y dólares americanos. Resultados: El costo promedio total de atención de caso en niños fue de 314,9 US$ (intervalo de confianza [IC] 95%: 280,1-349,7 US$) y de 971,6 (655,5-1.287,8 US$) para los que requirieron UCI. El 41% de los costos en los que solo requieren hospitalización general se explican por gastos de hotelería, mientras que en los que requieren UCI el 52% es por medicamentos. Conclusión: El microcosteo de los casos incluidos de IRAG permitió estimar un valor medio por caso tratado, con sus respectivos IC y estos podrían tener validez para el total de la población atendida por estos diagnósticos en hospitales con similar perfil epidemiológico y similar nivel de complejidad en Nicaragua.

Objective: To estimate the costs of treatment for severe acute respiratory infection (SARI) in children in Nicaragua. Methods: A cost assessment was carried out on a random sample of inpatients during 2009-2011 who were treated in one pediatric universitary hospital in Nicaragua. A random sample of patients diagnosed with SARI (ICD-10) was calculated based on parameters from the literature. The average cost per patient was estimated. Costs were expressed in local currency and US dollar values in 2011. Results: The total average cost of healthcare per case was US$314.9 (confidence interval [CI]95%: 280.10-US$349.70) and US$971.60 (655.50-US$1287.80) for those requiring intensive care unit (ICU). Around 41% of the general hospitalization costs are due to the cost of the hospitalization while for those costs involving ICU care, 52% are due to drugs costs. Conclusion: We estimated an average cost per case expressed with their respective CI by microcosts analysis for SARI health care in Nicaraguan children. These costs may be representative of the population with this diagnosis in Nicaraguan hospitals with similar epidemiological profile.

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.

Infección respiratoria aguda grave en pacientes cubanos durante la ola de influenza pandémica A (H1N1) en Cuba, 2009 / Severe acute respiratory infection in Cuban patients during the influenza A (H1N1) pandemic in Cuba, 2009

INTRODUCCIÓN: en abril de 2009 las autoridades de salud de México reportan a la Organización Panamericana de la Salud un incremento de las hospitalizaciones por neumonía con tasas elevadas de mortalidad. El Sistema Nacional de Vigilancia Epidemiológica, notó que este incremento se presentaba fundamentalmente en las edades de 20 a 40 años. Se identificó un nuevo virus influenza A de origen porcino subtipo (H1N1) como agente causal de la primera pandemia del siglo XXI. El 26 de abril de 2009 el plan nacional de enfrentamiento a la pandemia por influenza (H1N1) es activado por las autoridades nacionales de salud de la República de Cuba y el 7 de mayo se diagnosticó el caso índice de influenza pandémica (H1N1) en Cuba. Se estableció un sistema de vigilancia integrada con confirmación de laboratorio. OBJETIVOS: detectar e identificar el virus de la influenza pandémica durante la ola pandémica. MÉTODOS: durante las semanas epidemiológicas de la 37 a la 41 se observó un alza en el número de atenciones médicas. En este período se seleccionaron para este análisis solo las muestras colectadas de pacientes con diagnóstico clínico de infección respiratoria aguda grave divididas en tres grupos fundamentales, 370 niños y adultos graves, 55 gestantes graves y 30 fallecidos. El diagnóstico fue realizado por reacción en cadena de la polimerasa en tiempo real para los virus de influenza pandémica y reacción en cadena de la polimerasa convencional para otros virus respiratorios. RESULTADOS: el virus de la influenza pandémica se detectó en 65, 20 y 9 casos, respectivamente. El virus de la influenza estacional A (H3N2) en 81 casos de infección respiratoria aguda grave, donde se incluyeron pacientes de todas las edades; 10 gestantes graves y en 5 fallecidos, los cuales fueron detectados por reacción en cadena de la polimerasa en tiempo real. Otros virus respiratorios también fueron monitoreados por reacción en cadena de la polimerasa a punto final. CONCLUSIONES: el análisis integral de estos resultados constituye un aporte a la vigilancia nacional y regional de los virus respiratorios para el perfeccionamiento de los programas de prevención y control de las infecciones respiratorias agudas.

INTRODUCTION: on April 2009, the Mexican health authorities reported increased hospitalization indexes caused by pneumonia with high mortality rates to the Pan-American Health Organization (PAHO). The National Epidemiological Surveillance System of Mexico noticed that this increase mainly occurred in the 20-40 year old population. A new type of swine influenza A (H1N1) virus was identified by laboratory studies as the etiological agent of the first pandemic of the 21st century. On April 26 2009, the National Anti-pandemic Plan was activated by the Cuban Ministry of Public Health, and on May 7th, the lab-confirmed index case appeared. An integrated surveillance system with laboratory confirmation was set up. OBJECTIVES: to detect pandemic influenza virus during the pandemic wave. METHODS: the epidemiological weeks 37 to 41 witnessed a rise of the number of sick people seen by the medical services. In this period, the samples taken from patients clinically diagnosed with severe acute respiratory infection were selected for this analysis; they were divided into three groups, that is, 370 children and adults in critical condition, 55 pregnant women in severe condition and 30 fatal cases. The diagnosis of the pandemic virus was performed by Real Time Polymerase Chain Reaction Test (PCR). Other respiratory viruses were tested by conventional PCR. RESULTS: the pandemic influenza virus was detected in 65 children and adults, 20 pregnant women and 9 fatal cases. The seasonal influenza A (H3N2) virus was identified in 81 cases of severe acute respiratory infection covering all age groups, 10 pregnant women and 5 deceased on the basis of real time polymerase chain reaction test. Other respiratory viruses were also monitored by the end-point polymerase chain reaction. CONCLUSIONS: the comprehensive analysis of these results contributes to the national and regional surveillance of respiratory viruses for the improvement of the prevention and control programs of the acute respiratory infections.