Nota Técnica N. 3/2023 - SES/GVEDT: Nota técnica de Síndrome Gripal (SG) e Síndrome Respiratória Aguda Grave (SRAG) pelo vírus influenza / Technical Note N. 3/2023 - SES/GVEDT: Technical Note on Influenza Syndrome (SG) and Severe Acute Respiratory Syndrome (SARS) due to the influenza virus

A vigilância d influenza no Brasil é composta pela vigilância sentinela de Síndrome Gripal (SG), Síndrome Respiratória Grave (SRAG) em pacientes hospitalizados ou óbitos e em surtos de SG em instituições e de longa permanência. As unidade sentinelas de Síndrome Gripal têm como objetivo monitorar a circulação dos vírus respiratórios com ênfase em influenza e Sars-CoV-2, identificar as variações sazonais por faixa etária, prover cepas virais para formulação de vacinas de influenza, vigilância genômica do coronavírus, e identificar situações inusitadas

Influenza surveillance in Brazil is composed of sentinel surveillance of Influenza Syndrome (SG), Severe Respiratory Syndrome (SARS) in hospitalized or deceased patients and in SG outbreaks in institutions and long-term care facilities. The flu syndrome sentinel units aim to monitor the circulation of respiratory viruses with emphasis on influenza and Sars-CoV-2, identify seasonal variations by age group, provide viral strains for the formulation of influenza vaccines, genomic surveillance of the coronavirus, and identify unusual situations

Covid-19 y gripe de 1918-1919: paralelos históricos, preguntas y respuestas / Covid-19 and the 1918-1919 influenza: historical parallels, questions and answers

Resumen El desarrollo de la pandemia de la covid-19 ha motivado un renovado interés por la gripe de 1918-1919 para buscar elementos que facilitaran la comprensión de la experiencia presente, pero también como oportunidad para reevaluar la grave crisis sanitaria del siglo XX a la luz de lo que estamos viviendo. En este contexto y con ese objetivo se inserta esta reflexión histórica sobre estos dos fenómenos pandémicos, que muestra los paralelismos existentes y la necesidad de una toma de conciencia de que nuestro modelo de sociedad está en crisis y se requiere una transformación profunda.

Abstract The rise of the covid-19 pandemic has led to renewed interest in the 1918-1919 influenza in search of aspects that might help us understand the current situation, but also as an opportunity to re-evaluate the serious twentieth-century health crisis in light of what we are experiencing now. In this context and with that goal, this historical reflection shows the parallels that exist and the need for a realization that our model of society is undergoing a crisis and requires profound transformation.

Remedios curativos y propaganda médica contra la influenza de 1918 en México: ideas y conocimientos / Therapeutic remedies and medical propaganda on influenza in Mexico in 1918: ideas and knowledge sets

Resumen El artículo explora el pensamiento médico en torno al impacto de la pandemia de influenza de 1918 en México. Se analizan las ideas científicas sobre la etiología de la gripe, las cuales se reflejaron en el tipo de remedios y recetas médicas que se publicaron en la prensa y en boletines de salud. Para adentrarse en este tema profundizamos en el contexto histórico internacional dominado por la guerra. En México, años de conflictos armados a consecuencia de la Revolución agravaron las condiciones de vida de la población: hambre, tifo, viruela y otros padecimientos infecciosos se presentaron antes y durante el brote de la pandemia. El trabajo se apoya en documentación de archivo, boletines de salud, prensa de la época y bibliografía actualizada.

Abstract This article explores medical thought on the impact of the influenza pandemic of 1918 in Mexico. It analyzes scientific ideas on the etiology of the flu, as reflected in the types of remedies and medical prescriptions published in the press and in health bulletins. It then goes deeper into the topic by examining the international historic context, dominated by the war. In Mexico, years of armed conflict unleashed by the Revolution exacerbated living conditions among the population: starvation, typhus, smallpox and other infectious diseases were present before and during the outbreak of the pandemic. This study is based on archival documentation, health bulletins, press sources from the period, and modern bibliography.

Severe acute respiratory infections (SARI) from influenza in adult patients in Chile: the experience of a sentinel hospital / La infección respiratoria aguda grave asociada a la gripe en pacientes adultos en Chile: experiencia de un hospital centinela / Infecção respiratória aguda grave (SARI) decorrente da influenza em pacientes adultos no Chile: experiência de um hospital-sentinela

ABSTRACT Objective To 1) describe clinical characteristics of adult patients in Chile with severe acute respiratory infections (SARI) associated with influenza viruses, and 2) analyze virus subtypes identified in specimens collected from those patients, hospital resources used in clinical management, clinical evolution, and risk factors associated with a fatal outcome, using observational data from the SARI surveillance network (SARInet). Methods Adults hospitalized from 1 July 2011 to 31 December 2015 with influenza-associated SARI at a SARI sentinel surveillance hospital in Santiago were identified and the presence of influenza in all cases confirmed by reverse transcription polymerase chain reaction (RT-PCR), using respiratory samples. Results A total of 221 patients (mean age: 74.1 years) were hospitalized with influenza-associated SARI during the study period. Of this study cohort, 91.4% had risk factors for complications and 34.3% had been vaccinated during the most recent campaign. Pneumonia was the most frequent clinical manifestation, occurring in 57.0% of the cohort; other manifestations included influenza-like illness, exacerbated chronic bronchitis, decompensated heart failure, and asthmatic crisis. Cases occurred year-round, with an epidemic peak during autumn-winter. Both influenza A (H1N1pdm09 and H3N2) and B virus co-circulated. Critical care beds were required for 26.7% of the cohort, and 19.5% needed ventilatory assistance. Multivariate analysis identified four significant factors associated with in-hospital mortality: 1) being bedridden (adjusted odds ratio (aOR): 22.3; 95% confidence interval (CI): 3.0-164); 2) admission to critical care unit (aOR: 8.9; CI: 1.44-55); 3) Pa02/Fi02 ratio < 250 (aOR: 5.8; CI: 1.02-33); and 4) increased serum creatinine concentration (> 1 mg/dL) (aOR: 5.47; CI: 1.20-24). Seasonal influenza vaccine was identified as a significant protective factor (aOR: 0.14; CI: 0.021-0.90). Conclusions Influenza-associated SARI affected mainly elderly patients with underlying conditions. Most patients evolved to respiratory failure and more than one-quarter required critical care beds. Clinical presentation was variable. Death was associated with host characteristics and disease-associated conditions, and vaccine was protective. Virus type did not influence outcome.

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RESUMO Objetivo Descrever as características clínicas de pacientes adultos com infecção respiratória aguda grave (SARI) associada ao vírus da influenza e analisar os subtipos virais identificados em amostras coletadas destes pacientes, os recursos hospitalares empregados no tratamento clínico, a evolução clínica e os fatores de risco clínicos associados a um desfecho fatal, a partir de dados observacionais da rede de vigilância de SARI (SARInet) no Chile. Métodos Foram identificados os adultos hospitalizados com SARI associada a influenza em um hospital-sentinela de vigilância de SARI, em Santiago, de 1o de julho de 2011 a 31 de dezembro de 2015. A ocorrência de influenza foi confirmada em amostras respiratórias em todos os casos com a reação em cadeia da polimerase via transcriptase reversa (RT-RCP). Resultados Ao todo, 221 pacientes (idade média de 74,1 anos) foram hospitalizados com SARI associada a influenza no período de estudo. Nesta coorte, 91,4% apresentavam fatores de risco para complicação e 34,3% haviam sido vacinados na última campanha de vacinação. Pneumonia foi a manifestação clínica mais frequente, ocorrendo em 57,0% da coorte. Outras manifestações foram doença gripal, bronquite crônica exacerbada, insuficiência cardíaca descompensada e crise asmática. Os casos estiveram distribuídos ao longo do ano, com pico epidêmico no outono-inverno. Houve circulação simultânea dos vírus da influenza A (H1N1pdm09 e H3N2) e B. Leitos de terapia intensiva foram necessários em 26,7% da coorte e suporte ventilatório, em 19,5%. Na análise multivariada, quatro fatores importantes associados à mortalidade hospitalar foram identificados: estar restrito ao leito (odds ratio ajustado [ORaj] 22.3; intervalo de confiança de 95% [IC 95%] 3.0-164); ser admitido na unidade de terapia intensiva (ORaj 8.9, IC 95% 1.4 4-55); relação Pa02/Fi02 <250 (ORaj 5.8; IC 95% 1.02-33) e aumento da creatinina sérica (>1 mg/dl) (ORaj 5.47; IC 95% 1.20-24). A vacinação sazonal contra influenza foi identificada como importante fator de proteção (ORaj 0.14; IC 95% 0.021-0.90). Conclusões A SARI associada a influenza acometeu sobretudo pacientes idosos com doenças preexistentes. A maioria dos pacientes evoluiu com insuficiência respiratória e mais de um quarto precisou de cuidados intensivos. O quadro clínico foi variável. Morte foi associada às características do hospedeiro e problemas relacionados à doença. A vacinação teve efeito protetor e o tipo viral não influiu no desfecho.

Evaluación in silico de una epidemia de influenza aviar AH5N1 con transmisión humano-humano: efecto de las medidas sanitarias en Valencia, Venezuela, 2012 / In silico evaluation of an aviar influenza AH5N1 virus outbreak with human to human transmission: effects of sanitary measures in Valencia, Venezuela, 2012

Introducción: Existe el riesgo de una pandemia de influenza aviar por virus AH5N1. Objetivo: Conocer la magnitud e impacto en áreas latinoamericanas de una pandemia AH5N1 a fin de planificar las medidas sanitarias para reducir la morbimortalidad. Material y Método: Mediante el simulador InfluSim se modeló una epidemia por virus AH5N1 con transmisión Humano-Humano, en Valencia, Venezuela. Se calculó el día de máximo número de casos, cantidad de enfermos moderados, graves, expuestos, muertos, y costos en cinco escenarios diferentes: sin intervención sanitaria; tratamiento antiviral; reducción en 20% del contacto en la población; cierre de 20% de las instituciones educativas; reducción de 50% de las reuniones públicas. Parámetros usados: Población: 829.856 habitantes, Porcentaje de riesgo 6-47%, Contagiosidad índice (Ro) 2,5; Contagiosidad relativa 90%, Tasa de letalidad global 64,1 %, costos según Canasta Básica oficial. Resultados: En 200 días de epidemia: Muertes totales por escenario: a: 29.907; b: 29.900; c: 9.701; d: 29.295 y d: 14.752. Similar tendencia en costos. Discusión: Reducir 20% los contactos de la población produjo una reducción significativa de 68% en el número de casos. La epidemia colapsará los sistemas de salud disponibles por cantidad de casos. El tratamiento antiviral no es eficiente durante la epidemia. La reducción en los contactos interpersonales muestra ser la mejor medida sanitaria.

Background: There is a risk for an avian influenza AH5N1 virus pandemia. Aim : To estimate the magnitude and impact of an AH5N1 pandemic in areas of Latin-America in order to design interventions and to reduce morbidity-mortality. Methods : The InfluSim program was used to simulate a highly pathogenic AH5N1 aviar virus epidemic outbreak with human to human transmission in Valencia, Venezuela. We estimated the day of maximal number of cases, number of moderately and severely ill patients, exposed individuals, deaths and associated costs for 5 different interventions: absence of any intervention; implementation of antiviral treatment; reduction of 20% in population general contacts; closure of 20% of educational institutions; and reduction of 50% in massive public gatherings. Simulation parameters used were: population: 829.856 persons, infection risk 6-47%, contagiousness Index Rh o 2,5; relative contagiousness 90%, overall lethality 64,1% and, costs according to the official basic budget. Results: For an outbreak lasting 200 days direct and indirect deaths by intervention strategies would be: 29,907; 29,900; 9,701; 29,295 and 14,752. Costs would follow a similar trend. Discussion: Reduction of 20% in general population contacts results in a significant reduction of up to 68% of cases. The outbreak would collapse the health care system. Antiviral treatment would not be efficient during the outbreak. Interpersonal contact reduction proved to be the best sanitary measure to control an AH5N1 theoretical epidemic outbreak.

Protocolo de tratamento de influenza: 2013 / Influenza treatment protocol: 2013 / Protocolo de tratamiento de influenza: 2013

Em março de 2013, com base no perfil epidemiológico da influenza no Brasil,o Ministério da Saúde realizou, em parceria com a Sociedade Brasileira de Infectologia(SBI), a Sociedade Brasileira de Pneumologia e Tisiologia (SBPT),a Associação de Medicina Intensiva Brasileira (AMIB), a Sociedade Brasileirade Pediatria (SBP), a Sociedade Brasileira de Medicina da Família eComunidade (SBMFC) e a Federação Brasileira de Ginecologia e Obstetrícia(Febrasgo), uma revisão do Protocolo de Tratamento de Influenza, com destaquepara a importância do tratamento oportuno dos casos de SíndromeGripal (SG) que têm indicação para tal e de Síndrome Respiratória AgudaGrave (SRAG). Para tanto, foram revisadas e redefinidas algumas condutas aserem instituídas frente aos casos de influenza e atualizou-se de forma amplaas indicações de quimioprofilaxia.Este protocolo tem o objetivo de orientar a conduta terapêutica aos casos deSG e SRAG no país, bem como as medidas de controle a serem estabelecidas,tanto em ambientes domiciliares como em instituições fechadas, além das medidasde controle de infecção hospitalar...

Evidence for avian H9N2 influenza virus infections among rural villagers in Cambodia

Southeast Asia remains a critical region for the emergence of novel and/or zoonotic influenza, underscoring the importance of extensive sampling in rural areas where early transmission is most likely to occur. In 2008, 800 adult participants from eight sites were enrolled in a prospective population-based study of avian influenza [AI] virus transmission where highly pathogenic avian influenza [HPAI] H5N1 virus had been reported in humans and poultry from 2006 to 2008. From their enrollment sera and questionnaires, we report risk factor findings for serologic evidence of previous infection with 18 AI virus strains. Serologic assays revealed no evidence of previous infection with 13 different low-pathogenic AI viruses or with HPAI avian-like A/Cambodia/R0404050/2007[H5N1]. However, 21 participants had elevated antibodies against avian-like A/Hong Kong/1073/1999[H9N2], validated with a monoclonal antibody blocking ELISA assay specific for avian H9. Although cross-reaction from antibodies against human influenza viruses cannot be completely excluded, the study data suggest that a number of participants were previously infected with the avian-like A/Hong Kong/1073/1999[H9N2] virus, likely due to as yet unidentified environmental exposures. Prospective data from this cohort will help us better understand the serology of zoonotic influenza infection in a rural cohort in SE Asia

Brote de influenza A (H1N1) humano en pavos en un criadero comercial, Valparaíso, Chile: 2009 / Outbreak of human A (H1N1) influenza in turkeys of a commercial poultry farm, Valparaiso, Chile: August 2009

The Chilean Ministry of Health (MINSAL) led an investigation to identify associated factors to human influenza A (H1N1) infection in turkeys from poultry farms, Valparaíso. The Agriculture and Livestock Farming Service (SAG) informed the detection of influenza A (low pathogenicity) in turkeys and the Public Health Institute (ISP) confirmed influenza A (H1N1).The study included 100% of operative wards: 31% presented positive event (influenza A (H1N1)); 60% if considered only reproductive wards. Dissemination and dispersion velocity of 13 wards in 18 days evidenced a continuous common source. Interviews were performed to 89% of workers of whom 20% presented influenza-like disease: 26% from reproductive wards and 4% from raising and rearing farms. Of15 risk factors studied insemination and age in females showed statistically significant RR in low oviposition index wards. A man-bird transmission is proposed, through direct transmission of saliva during manual insemination or indirect transmission through contaminated semen. To the authors, this is the first turkey 2009 influenza H1N1 outbreak detected worldwide,in this case with a documented cloacal transmission path.

El MINSAL lideró una investigación para identificar factores asociados a infección por influenza A(H1N1) en pavos de planteles avícolas, Valparaíso. El Servicio Agrícola Ganadero informó la detección de influenza A (baja patogenicidad) en pavos y el ISP confirmó influenza A(H1N1). El estudio incluyó 100% de los pabellones operativos: 31% presentó evento positivo (influenza A(H1N1); 60% al considerar sólo pabellones de reproducción. La diseminación y velocidad de dispersión de 13 pabellones en 18 días evidenció una fuente común continua. Se entrevistó a 89% de los trabajadores y 20% presentó ETI: 26% de pabellones de reproducción y 4% de granjas de cría y recría. De 15 factores analizados, inseminación y edad de las hembras mostraron RR estadísticamente significativos en los planteles con baja ovipostura. Se plantea transmisión hombre-ave directa por saliva en inseminación manual o transmisión indirecta por semen contaminado. Es el primer brote de influenza A(H1N1) 2009 en pavos detectado en el mundo y que se comprueba vía de transmisión cloacal.

Influenza due to a Novel Influenza A (H1N1)/09 Virus.

The influenza A(H1N1) virus originating in Mexico has shaken the political, economical and health system of the whole world. It produces flu like symptoms in human body and is responsible for producing high morbidity than mortality.

New Human case of avian influenza A [H5N1] in Egypt

The Ministry of Health and Population in Egypt reported two new cases of human infection with avian influenza A [H5N1] virus during the months of December-January 2012. In addition, the Ministry also retrospectively reported one new cases with the date of onset of symptoms on 30 October 2011. Of these newly reported cases, one was fatal. Thus, the total number of confirmed cases of human infection with avian influenza A [H5N1] reported from Egypt rose to 159 including 55 deaths. All these newly reported cases had exposure to sick chicken in the backyard poultry

Three new human cases of avian influenza A/[H5N1] in Egypt

The Egyptian Ministry of Health and Population has reported three new cases of avian influenza A/[H5N1] in February 2012. There was no related death. All the patients are receiving Oseltamivir. The cases were confirmed by the Central Public Health Laboratories; a National Influenza Center of the WHO Global Influenza Surveillance Network. So far, four cases of A[H5N1] are now reported since the beginning of the year. In total the number of human cases of A/[H5N1] reported since 2006 in Egypt is now 162 including 55 deaths [CFR 33.9%]

Predictibilidad de la propagación espacial y temporal de la epidemia de influenza A H1N1 en la Argentina por el método de percolación

La epidemia de influenza A H1N1 se expandió rápidamente a nivel mundial dadas las actuales condiciones de alta interconectividad y velocidad de los transportes, imperantes tanto entre las personas como entre los países y las regiones. La diseminación espacial de la epidemia puede ser explicada mediante la teoría de la percolación, que permite estimar un umbral más allá del cual se produce el traspaso de la epidemia entre distintas regiones geográficas. El objetivo de este trabajo fue probar la capacidad predictiva del modelo de percolación aplicado al análisis de la epidemia de influenza A H1N1 registrada en la Argentina en 2009, de acuerdo a los datos relevados por el Ministerio de Salud Pública de la Nación. Para aplicar el mencionado modelo se consideró al país como un conjunto de figuras geométricas irregulares, contiguas y continuas, que pueden representarse en dos dimensiones en una carta geográfica plana. Se analizó la proporción de provincias infectadas en el momento de la percolación con respecto al tiempo y se compararon los valores observados con los esperados mediante ecuaciones de estimación curvilínea en un modelo logístico. La percolación ocurrió en el día 45. El valor esperado que generó el modelo fue de 42,4 días, intervalo de confianza de 95 % 28,5-56,3. La diferencia entre el valor observado y el esperado arrojó un valor de p = 0,997. Se concluye que el modelo posee un buen ajuste y una adecuada capacidad predictiva.

Spatial and temporal spread predictability of influenza A H1N1 epidemic in Argentina by the percolation method. The influenza A H1N1 epidemic has spread rapidly worldwide on account of the current conditions of high interconnectivity and transport speed both among people and countries. The spatial spread of the epidemics can be explained by the percolation theory which allows to estimate a threshold beyond which the transmission of the infection among different geographic regions occurs. The aim of this study was to test the predictive ability of the percolation model of influenza A H1N1 epidemic in Argentina according to data gathered by the National Department of Public Health. In the model, the country was considered as a set of irregular, contiguous and continuous geometric figures, which can be represented in two dimensions on a plane. We analyzed the proportion of infected provinces at the moment of percolation in relation to time in days and compared observed and expected values by curvilinear equations in a logistic model. Percolation occurred on day 45. The expected value generated by the model was 42.4 days, 95 % CI 28.5 to 56.3. The difference between observed and expected values was p = 0.997. We conclude that the model has good fit and predictive capacity.

Vigilância sanitária do posto aeroportuário de Guarulhos diante da pandemia de Influenza A (H1N1), 2009 / Health surveillance of Guarulhos airport facing the pandemic A/H1N1, 2009

Introdução: A Vigilância Sanitária se constitui como campo de intervenção da Saúde Pública tendo como uma de suas responsabilidades, garantir o controle sanitário de aeroportos e a proteção da saúde dos viajantes. Objetivo: Neste sentido, o presente estudo teve como objetivo conhecer, descrever e analisar a prática sanitária adotada frente à Pandemia de Influenza A (H1N1) 2009, pela Vigilância Sanitária no Terminal de Passageiros do Aeroporto de Guarulhos. Metodologia: A pesquisa qualitativa foi adotada, tendo como referencial teórico as representações sociais. Utilizou-se o referencial metodológico da hermenêutica dialética, fazendo uso de uma abordagem interpretativa reconstrutiva das falas dos entrevistados. A construção das três categorias empíricas Trabalho, Comunicação, Intersetorialidade - permitiu resgatar junto às falas dos profissionais pesquisados a prática vivenciada pela Vigilância Sanitária durante a pandemia. Resultados: Pôde-se apreender que as dificuldades evidenciadas durante a Pandemia de H1N1 estiveram relacionadas aos recursos humanos, à estrutura física e de material, ao fluxo de procedimentos e de informações. Conclusões: Os resultados evidenciaram a prática da VISA associada diretamente a sua estrutura organizacional; a uma atuação coadunada com o desenvolvimento atual do país; e uma experiência que serviu como o mais importante e único teste de enfrentamento para uma pandemia de influenza.

New cases of Avian influenza A [H5N1] in Egypt

The Ministry of Health in Egypt reported 5 new human cases of avian influenza A [H5N1] virus during the month of May. Of these cases, 3 were fatal. This brings the total number of reported human infections with avian influenza A[H5N1] in Egypt to 149. Of these cases reported so far from Egypt, 51 have been fatal [CFR: 34.2%]

New case of avian influenza A [H5N1] in Egypt

The Ministry of Public Health in Egypt has reported a new case of human infection with avian influenza, A [H5N1] virus. The case is a fourteen month old male child from Gharbia Governorate, Mahala District. He developed symptoms on 17th September 2011, received Tami flu on 21st September. The patient has recovered fully. Laboratory confirmation was done at the Central Public Health Laboratory and NAMRU-3 on 29th September and 2nd October 2011 respectively. Investigations into the source of infection indicated the child had exposure to backyard poultry. This brings the number of confirmed cases in Egypt to 152 and 52 of them have been fatal

New human case of avian influenza A [H5N1] in Egypt

The Ministry of Health and Population in Egypt has reported three new cases of human infection with avian influenza A [H5N1] virus in November and one new case in December 2011. Of these newly reported cases, two were fatal. Thus, the total number of confirmed cases of human infection with avian influenza A [H5N1] reported from Egypt rose to 156 including 54 deaths. All these newly reported cases had exposure to sick chicken in the backyard poultry. However, upon investigation it was also found that at-least three of the newly reported cases were found to have been epidemiologically linked to each other hailing from the same district. Further investigations are ongoing on this cluster of cases found in the same district

2009H1N1 Infection in a 1-day-old neonate.

A full-term female neonate was delivered with meconium stained amniotic fluid by cesarean section by a 2009H1N1 positive 22-year-old second gravida mother, who developed symptoms 8 days prior to delivery. The neonate was completely and immediately isolated from the mother after delivery. Oseltamivir was started at birth to the neonate who had a potential possibility of 2009H1N1 infection. At 5 hours of life, the neonate developed respiratory distress. The neonate's throat swab sent for 2009H1N1 by real-time polymerase chain reaction (RT-PCR) assay was positive. The neonate required oxygen by hood for 3 days and made an uneventful recovery. The mother developed acute respiratory distress syndrome after delivery, requiring ventilatory care for 14 days and was discharged after 25 days stay in hospital. 2009H1N1 infection, although rare, needs a high index of suspicion and prompt therapy in neonates. Clinicians should be alert about the possibility of perinatal transmission of 2009H1N1.