Clinical and Epidemiological profile of SARS-CoV-2 in patients with Severe Acute Respiratory Illness (SARI) at a tertiary care hospital of North India.

Background: Severe acute respiratory illness due to SARS-CoV-2 represents great global public health concern. The spectrum of disease ranges from mild to life-threatening. Surveillance of hospitalized patients with severe acute respiratory infections (SARI) is an important public health tool used to identify etiologies to understand the disease, track changes in circulating viruses and as an alert mechanism for potential pandemic viruses. We aim to find out the rate of SARS-CoV-2 positivity in SARI cases and further study the epidemiological and clinical characteristics of patients.Material & Methods:A Prospective study was conducted on 200 Severe Acute Respiratory Illness patients admitted at tertiary care hospital. The clinical, demographic, epidemiological, risk factors / co-morbidities of all the patients were recorded. Oropharyngeal and nasopharyngeal samples were collected and tested for SARS-CoV-2 by real time reverse transcriptase (RT-PCR) test.Results:Out of 200 SARI patients, 51 (25.5%) were tested positive for SARS-CoV-2. Maximum cases (54.90%) were in the age group of 41-60 years; males were infected predominantly (52.94%). The most common symptoms of presentation were fever (100%), cough (86.27%), dyspnoea (82.35%) and sore throat (56.86%). Comorbidities associated with COVID-19 were Hypertension (56.86%), Diabetes Mellitus (33.33%), Chronic Obstructive Pulmonary Disease (13.72%) and Coronary Artery disease (9.8%). More than 30% of the patients were admitted in ICU and 9.80% received mechanical ventilation.Conclusions:Evaluation of clinical and epidemiological profiles of SARI patients can help in understanding and managing the outbreak more efficiently. Close monitoring and quarantine will be required to prevent extensive transmission within the community.

Do children with severe acute respiratory infection need cohorting & isolation before screening for COVID-19?

This retrospective analysis was done to ascertain the SARS-CoV-2-positivity rate in children (0-12 yr) with severe acute respiratory infection (SARI) and compare it to those without SARI to determine the need for running a dedicated SARI isolation facility for paediatric COVID-19 care. The case records of 8780 children (0-12 yr) admitted and/or tested for SARS-CoV-2 between June 2020 and May 2021 at a tertiary care centre in north India were analyzed. The overall SARS-CoV-2 reverse transcription (RT)-PCR positivity rate was 3.0 per cent (262/8780). There were 1155 (13.15%) children with SARI. Fifty of these 1155 (4.3%) children with SARI, as against 212 of the 7625 (2.8%) children without SARI, tested positive for COVID-19. The absolute difference in the positivity rate among SARI and non-SARI groups was only 1.54 per cent which translates to cohorting and isolating 65 children with SARI to pick up one extra SARS-CoV-2-positive child (compared to those without SARI). The positive predictive value of SARI as a screening test was 4.3 per cent. Our findings suggest that isolation of children with SARI as a transmission-prevention strategy for COVID-19 may not be required. This is particularly relevant in resource-limited settings.

Imputation method to reduce undetected severe acute respiratory infection cases during the coronavirus disease outbreak in Brazil

Abstract INTRODUCTION: The coronavirus disease (COVD-19) outbreak has overburdened the surveillance of severe acute respiratory infections (SARIs), including the laboratory network. This study was aimed at correcting the absence of laboratory results of reported SARI deaths. METHODS: The imputation method was applied for SARI deaths without laboratory information using clinico-epidemiological characteristics. RESULTS: Of 84,449 SARI deaths, 51% were confirmed with COVID-19 while 3% with other viral respiratory diseases. After the imputation method, 95% of deaths were reclassified as COVID-19 while 5% as other viral respiratory diseases. CONCLUSIONS: The imputation method was a useful and robust solution (sensitivity and positive predictive value of 98%) for missing values through clinical & epidemiological characteristics.

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.

The influenza season 2016/17 in Bucharest, Romania - surveillance data and clinical characteristics of patients with influenza-like illness admitted to a tertiary infectious diseases hospital

ABSTRACT Background: Influenza continues to drive seasonal morbidity, particularly in settings with low vaccine coverage. Objectives: To describe the influenza cases and viral circulation among hospitalized patients. Methods: A prospective study based on active surveillance of inpatients with influenza-like illness from a tertiary hospital in Bucharest, Romania, in the season 2016/17. Results: A total of 446 patients were tested, with a balanced gender distribution. Overall, 192 (43%) patients tested positive for influenza, with the highest positivity rate in the age groups 3-13 years and >65 years. Peak activity occurred between weeks 1 and 16/2017, with biphasic distribution: A viruses were replaced by B viruses from week 9/2017; B viruses predominated (66.1%). Among the 133 (69.3%) subtyped samples, all influenza A were subtype H3 (n = 57) and all influenza B were B/Victoria (n = 76). Patients who tested positive for influenza presented fewer comorbidities (p = 0.012), except for the elderly, in whom influenza was more common in patients with comorbidities (p = 0.050). Disease evolution was generally favorable under antiviral treatment. The length of hospital stay was slightly longer in patients with influenza-like illness who tested patients negative for influenza (p = 0.031). Conclusions: Distinctive co-circulation of A/H3 and B/Victoria in Bucharest, Romania in the 2016/17 influenza season was found. While the A/H3 subtype was predominant throughout Europe that season, B/Victoria appears to have circulated specifically in Romania and the Eastern European region, predominantly affecting preschoolers and school children.

Analysis on hemagglutinin gene characterizes of avian influenza A (H7N9) virus infection in Suzhou city during 2016—2017 / 中华实验和临床病毒学杂志

Objective@#To analyze epidemiological and genetic characteristics of the fifth avian influenza A (H7N9) wave in Suzhou, and to provide scientific basis for prevention and control of H7N9 virus infection.@*Methods@#Respectively, influenza A/B, H1N1 (pdm09), H3, H5N1, and H7N9 real-time PCR kits were used to detected pharyngeal swab samples which were collected from severe acute respiratory syndrome infection (SARI) cases in Suzhou. The H7N9-positive samples were further examined for virus isolation and gene sequencing.@*Results@#The H7N9 virus was mainly prevalent in winter in Suzhou City. In the fifth H7N9 virus epidemic, the overall fatality rate of human infection with H7N9 virus in Suzhou city was 40% (22/55). Additionally, most were older people (median age was 58 years) and more than 80% of H7N9 patients had live poultry exposure history. The nucleic acid homology of HA gene was 98.7-100%. There were no mutations in the key sites of the HA gene sequence.@*Conclusions@#The H7N9 virus can not be effectively spread in the crowd currently, with no significant changes in receptor binding sites (RBS). In addition, exposure to live poultry or contaminated environment is still the main source of human infection with H7N9. At present, the viruses circulating in Suzhou city are low pathogenic to poultry.

Mechanism of SARI gene promoting apoptosis in acute myeloid leukemia cells / 中国免疫学杂志

Objective:To explore the apoptotic mechanisms of acute myeloid leukemia(AML) cells by a lentivirus mediated-SARI(suppressor of AP-1,regulated by IFN) overexpression system.Methods: The lentiviral vectors of overexpression SARI were transfected into AML cell HL-60 and NB4.Real-time quantitative PCR and Western blot were employed in the following evaluation tests.Both the cells were all divided into blank control group(CON group),empty vector control group(NC group)and SARI overexpression group(SARI group).Western blot was used to detect the expressions of apoptosis-related proteins Bcl-2,Bcl-xl,Bax and apoptotic pathway related proteins CytoC,Caspase8,Caspase9,Caspase3,Actived-Caspase3,PARP.Results:The SARI groups exhibited a high level of SARI mRNA and SARI protein when compared with CON group and NC group(P<0.05).In both the SARI groups,the expression of anti-apoptotic proteins Bcl-2,Bcl-xl were down-regulated and the pro-apoptotic protein Bax was up-regulated.CytoC increased,Caspase8,Caspase9 and Caspase3 decreased,Actived-Caspase3 up-regulated.PARP down-regulated,and PARP spliced variant up-regulated.Conclusion: SARI might promote the apoptosis of AML cells through activing the exogenous and endogenous apoptotic pathways which crossed to exogenous.

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.