Influenza A(H1N1)pdm09 infection and viral load analysis in patients with different clinical presentations

BACKGROUND Influenza viral load (VL) can be a decisive factor in determining the antiviral efficacy in viral clearance. OBJECTIVE This study aimed to evaluate the rate of infection and the role of influenza VL on the clinical spectrum of illnesses among different patient groups attended at a tertiary hospital in Brazil. METHODS Samples were collected from patients presenting acute respiratory infection from 2009 to 2013. Overall, 2262 samples were analysed and distributed into three groups: (i) asymptomatic (AS); (ii) symptomatic outpatients (OP); and (iii) hospitalised patients (HP). VL (expressed in Log10 RNA copies/mL) was calculated through a quantitative real-time one-step reverse transcription-polymerase chain reaction (RT-PCR) assay aimed at the M gene, with human RNAseP target as internal control and normalising gene of threshold cycle values. FINDINGS A total of 162 (7.16%) H1N1pdm09 positive samples were analysed. Patients aged from 0.08 to 77 years old [median ± standard deviation (SD): 12.5 ± 20.54]. Children with 5 to 11 years old presented the highest detection (p < 0.0001). AS patients had the lowest VL, with a significant difference when compared with symptomatic patients (p = 0.0003). A higher VL was observed within two days of disease onset. Ten patients (HP group) received antiviral treatment and were followed up and presented a mean initial VL of 6.64 ± 1.82. A complete viral clearance for 50% of these patients was reached after 12 days of treatment. MAIN CONCLUSIONS It is important to evaluate AS patients as potential spreaders, as viral shedding was still present, even at lower VL. Our results suggest that patients with underlying diseases and severe clinical symptoms may be considered for prolonged viral treatment.

Características clínicas de pacientes pediátricos internados por Influenza A: comparación de dos subtipos virales (H1N1) y (H3N2) / Clinical characteristics of pediatric patients hospitalized due to Influenza A: comparison of two viral subtypes (H1N1 and H3N2)

Influenza is a respiratory disease ocasionated by influenza virus A and B. Is a disease with high morbi-mortality world-wide. Influenza produces an acute febrile respiratory illness with cough, headache and myalgias for 3-4 days, with simptoms that may persist for as long as 2 weeks. There are three types of influenza virsuses: A, B and C, of whom the type a has a higher ability to originate pandemias and is subclassified according to their surface antigens: hemaglutinine (H) and neuraminidase (N). Of the capacity of mutation that has the influenza virus and the consequent expression of different proteins, can modify its virulence. The transmission route is through direct contact with secretetory repirations. The transmission route is through direct contact with secretetory repirations. The incubation period is scant, between 12-72 hs. The aim of this study was to compare the clinical characteristics demographicals and evolutive of pediatric patients hospitalized because by Influenze A: subtypes H1N1 (pdm2009) and H3N2. An observative study was performed, retrospective, using data of hospitalizations of children during the years 2016 and 2017 with influenza A confirmed by laboratory. The study also, aimed to evaluate if the viral subtype constitutes a factor of risk, independent for complicated hospitalization (admission to intensive care and/or development of complications) in hospitalized children. The results obtained in the study are detailed in the paper. In conclusion, both viral subtypes affected mainly to children with risk factors. The viral subtype H1N1 was related with higher severety in hospitalized children. is of most importance to perform preventive works, specially in vulnerable groups, offering a good cover of immunizations. The clinical parameters arae commented (AU)

Cambios en la presentación clínica de la influenza A H1N1pdm09 después de la pandemia / Changes in the clinical presentation of Influenza A H1N1pdm09 after the pandemic

Background: After the 2009 influenza pandemic the H1N1pdm09 strain circulate seasonally. In 2015, Puerto Montt Hospital in Chile faced a simultaneous outbreak of both seasonal H3N2 and H1N1pdm09 influenza A (IA). Aim: To evaluate the clinical differences between the two viral strains and recent changes in the behavior of H1N1pdm09 IA. Material and Methods: We set up a retrospective study including every adult hospitalized in Puerto Montt Hospital in 2015 due to IA, confirmed by reverse transcription polymerase chain reaction. We compared epidemiological data, clinical presentation, complications, and the outcome of patients with H1N1pdm09 versus those with seasonal influenza. In parallel, we compared 62 cases of thatH1N1 IA from 2015 with 100 cases who were hospitalized and analyzed in 2009. Results: Between July and October 2015, 119 adults with confirmed IA were hospitalized. From 2009 to 2015, the mean age of patients with IAH1N1pdm09 increased from 40.4 ± 17 to 58.8 ± 16 years (p < 0.01). Pneumonia as the cause of hospitalization decreased from 75 to 58% of patients, (p = 0.04). Likewise, the presence of comorbidities increased from 53 to 74%, (p < 0.01). Compared with seasonal H3N2, patients with IAH1N1pdm09 IA were more likely to require intensive care (p < 0.01) and mechanical ventilation (p < 0.01) and developed septic shock (p = 0.03). Their mortality was non-significantly higher (13 and 5% respectively). Conclusions: The clinical presentation of H1N1pdm09 IA has varied over time and now affects an older population, with a greater number of comorbidities. It also appears to be adopting the clinical behavior of a classic seasonal influenza virus.

Burden of ARD in the EMR

Recently, a literature review on the burden of acute respiratory diseases of epidemic and pandemic potential in the Eastern Mediterranean Region [EMR] of WHO has been conducted

Molecular findings from influenza A(H1N1)pdm09 detected in patients from a Brazilian equatorial region during the pandemic period

After the World Health Organization officially declared the end of the first pandemic of the XXI century in August 2010, the influenza A(H1N1)pdm09 virus has been disseminated in the human population. In spite of its sustained circulation, very little on phylogenetic data or oseltamivir (OST) resistance is available for the virus in equatorial regions of South America. In order to shed more light on this topic, we analysed the haemagglutinin (HA) and neuraminidase (NA) genes of influenza A(H1N1)pdm09 positive samples collected during the pandemic period in the Pernambuco (PE), a northeastern Brazilian state. Complete HA sequences were compared and amino acid changes were related to clinical outcome. In addition, the H275Y substitution in NA, associated with OST resistance, was investigated by pyrosequencing. Samples from PE were grouped in phylogenetic clades 6 and 7, being clustered together with sequences from South and Southeast Brazil. The D222N/G HA gene mutation, associated with severity, was found in one deceased patient that was pregnant. Additionally, the HA mutation K308E, which appeared in Brazil in 2010 and was only detected worldwide the following year, was identified in samples from hospitalised cases. The resistance marker H275Y was not identified in samples tested. However, broader studies are needed to establish the real frequency of resistance in this Brazilian region.

Epidemiologia da Influenza A (H1N1) na região do Triângulo Mineiro eAlto Paranaíba, Minas Gerais - Brasil / Epidemiology of Influenza A (H1N1) in the TriânguloMineiro and high Paranaíba Regions, Minas Gerais – Brazil

Introdução: ainfluenza A, mais conhecida como gripe, é uma infecção viral aguda do sistema respiratório, altamente transmissível e de distribuição mundial. Há quatro anos o vírus Influenza A pandêmico (H1N1) 2009 surgiu no México e rapidamente se espalhou pelo mundo, provocando pandemia de grandes proporções, alertando para a extensão a cada ano da gripe sobre o ser humano. Objetivo: determinar a ocorrência de influenza A H1N1 na região do Triângulo Mineiro e Alto Paranaíba, administrados pela Gerência Regional de Saúde de Uberlândia, Minas Gerais, Brasil. Metodologia: os dados foram obtidos das fichas deInvestigação de Influenza Humana por novo subtipo (pandêmico), via SINAN, no período de junho de 2009 a julho de 2010. Foi avaliada a taxa de incidência, mortalidade e letalidade, assim como a frequência relativa dos fatores de risco. Resultados: 12 municípios na região apresentaram casos de influenza A (H1N1), com incidência de 9,14 casos para/100.000 habitantes, mais frequente em mulheres (65,4%) na faixa etária entre 20 a 49 anos e residentes principalmente em Uberlândia. Foram registrados 20 óbitos, com taxa de mortalidade de 1,2 casos/100.000 habitantes e letalidade de 23%. Conclusão: para o controle de grandes epidemiascomo a de influenza A (H1N1) são necessárias diversas e coordenadas ações de saúde pública voltadas para a prevenção e controle das doenças com tendências à pandemia.

Introduction: Influenza A, commonly known as the flu, is an acute viral infection of the respiratory system, highly transmissible and of worldwide distribution. Four years ago, the pandemic Influenza A (H1N1) virus of 2009 emerged in Mexico and quickly spread worldwide, causing a major pandemia, underscoring the yearly extension of flu among humans.Objective: To determine the occurrence of the influenza A H1N1 virus in the Triangulo Mineiro and High Parnaíba regions, as assessed by the Regional Health Division of Uberlândia, Minas Gerais, Brazil. Methodology: Data were obtained from the Investigation of Human Influenza by new (pandemic) subtype Report Sheets via SINAN, from June 2009 to July 2010. We evaluated incidence rate, mortality and lethality, as well as the relative frequency of risk factors. Results: 12 cities in the region had cases of influenza A (H1N1), with an incidence of 9.14 cases per 100,000 inhabitants, with a higher frequency in women (65.4%), aged 20-49 years-old and mainly citizens of Uberlândia. There were 20 deaths, with a mortality rate of 1.2 cases per 100,000 inhabitants and a mortality rate of 23%. Conclusion: for the control of major epidemics such as influenza A (H1N1) several coordinated public health interventions are required, aimed at the prevention and control of diseases with pandemic trends.

Symmetric peripheral gangrene associated with H1N1 infection

More and more cases of H1N1 influenza are being detected in India and so also the variety of complications this virus can cause. Here, we report a case of symmetric peripheral gangrene following H1N1 infection

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.

Features associated with severe disease in hospitalized children with 2009 influenza A [H1N1] infection at a university hospital in Riyadh, Saudi Arabia

In 2009, pandemic H1N1 influenza A caused significant morbidity and mortality worldwide; however, available data on disease characteristics and outcome of hospitalized children is limited. A prospective cohort study of children who required hospitalization because of the influenza A [H1N1] infection at King Khalid University Hospital in Riyadh, Saudi Arabia, over 6 months [July- December, 2009]. Data was collected using a predesigned form for all admitted pediatric cases [0-12 years] presenting with the influenza-like illness and who tested positive for the novel influenza [H1N1] using reverse transcriptase polymerase chain reaction assay. The clinical course and features associated with the severe disease among such children were described. Out of 1103 children with the influenza-like illness, 375 [34%] were confirmed pediatric cases of influenza A [H1N1], of whom 50 [13.3%] required hospitalization. The median age was 3 years [range, 1 month-12 years]. Fever was the most frequent symptom [94%] at admission, followed by cough [86%] and other symptoms including vomiting and diarrhea. The majority [70%] of children had at least one underlying medical condition, with bronchial asthma being the most common [40%]. All cases were treated with oseltamivir. Five children [10%] were admitted to the ICU, 4 required mechanical ventilation, and 2 died [4%].The majority of children with 2009 H1N1 influenza A-associated hospitalization in this series had an uncomplicated course. Respiratory complications and ICU admissions were more frequent in those with underlying disease, especially asthma and neuromuscular diseases. Efforts need to be focused prior to each influenza season and special emphasis needs to be given to children by immunizing them with H1N1 influenza A vaccination to avoid severe disease and minimize complications

2009 H1N1 influenza A in children: a descriptive clinical study

The 2009 H1N1 was a new influenza virus causing illness in people. Especially those younger than 5 years of age and those who have high-risk medical conditions are at increased risk for influenza-related complications. In the present study, we describe the clinical presentation of the H1N1 cases attending Jeddah Clinic Hospital-Al Kandarah [JCH-K] in the time period from October 2009 to January 2010, and identified the high-risk age groups. Prospective study at JCH-K from October 2009 through January 2010. All pediatric patients [up to 15 years old] presenting with influenza-like illnesses in the clinics during the specified period were clinically examined and tested using reverse transcriptase polymerase chain reaction. Only confirmed H1 N1 cases were included in the study. Over a 4-month period, 89 cases of laboratory-confirmed H1N1 were reported in JCH-K. Thirty-four patients [38.2%] were younger than 5 years of age. Forty-six [51.6%] cases were males. Thirty-three cases were Saudis [37.1%]. The most commonly reported symptom was fever, which was noted in all cases. Twenty-eight cases [31.5%] had pneumonia. Fourteen cases [15.7%] were known asthmatics. Fifty-two [58.4%] cases were lymphopenic and 32 [35.9%] cases were leucopenic. Sixty-five [73%] patients were hospitalized, and five of them were treated in the intensive care unit. Even though the majority of cases of the 2009 pandemic influenza A H1N1 were mild, a severe disease does occur in children. In view of delayed PCR results, clinical presentation and lymphopenia were used as diagnostic criteria to start antiviral treatment as early as possible. No deaths were attributed to the 2009 pandemic

Novel influenza A [HINI] virus-induced hemophagocytosis: first case reported in Saudi Arabia

H1N1 is a novel subtype of the influenza A virus. Since its reemergence in 2008, it has been reported to cause a variety of illnesses ranging from mild flu-like symptoms to severe multiorgan failure. We report a case of a young immunocompetent man who presented with progressive shortness of breath and rapidly developed multiorgan dysfunction, including pancytopenia from H1N1 infection during the 2010-2011 influenza season. His H1N1 pneumonia caused severe acute respiratory distress syndrome, respiratory failure requiring mechanical ventilation, rhabdomyolysis, myocarditis, hepatitis, encephalitis, and renal failure. During the diagnostic workup, a bone marrow biopsy was performed, showing hemophagocytosis secondary to the H1N1 infection. Unfortunately the patient died despite aggressive measures. Published reports contain only a few records of H1N1-induced hemophagocytosis. This is the first case report from Saudi Arabia with H1N1-induced secondary hemophagocytosis. It also highlights the fact that the virus is still very virulent and will pose a major annual health risk along with the seasonal influenza for at least the next few years

Características de gestantes y puérperas con enfermedad de tipo influenza durante la pandemia por A H1N1 / Characteristics of pregnant women and puerperae with influenza-like illness during the A(H1N1) pandemic

Introducción En el 2009, el hospital Enrique Cabrera de La Habana, fue designado como centro de atención a gestantes y puérperas de la capital con enfermedad de tipo influenza. Objetivo Caracterizar clínico-epidemiológicamente a las gestantes y puérperas no graves ingresadas en el centro. Métodos Estudio observacional descriptivo y transversal realizado entre julio de 2009 y Junio de 2010. En el período ingresaron 2 793 pacientes, de ellas, 2 693 gestantes y 100 puérperas. Resultados La edad media de las pacientes fue 27 años (15-45), la edad gestacional 29,5 semanas (9,4-41) y la estadía media de 5,7 días. La tos seca (66,6 por ciento), congestión/secreción nasal (57,5 por ciento) y cefalea (45,5 por ciento) fueron los síntomas más frecuentes. Tuvieron complicaciones 629 (22,5 por ciento) pacientes, las más frecuentes, bronconeumonía (12,6 por ciento) y asma bronquial persistente (7,8 por ciento), que además fue el factor de riesgo más frecuentes (12,6 por ciento). No hubo fallecidas en este grupo de pacientes. Conclusiones La vigilancia epidemiológica, el diagnóstico precoz, el tratamiento inmediato y multidisciplinario cumpliendo lo establecido en los protocolos médicos en todos las casos, fueron factores determinantes en los resultados satisfactorios contra la pandemia A H1N1

Introduction In 2009, Enrique Cabrera hospital in La Habana was designated as the center of medical care to pregnant women and puerperae with influenza-like illness in the capital. Objective Clinical and epidemiological characterization of non- serious cases of pregnant women and puerperae admitted to the center. Methods Descriptive and cross-sectional study conducted from July 2009 to June 2010. In this period, 2 793 patients were admitted of whom 2 693 pregnant and 100 puerperae. Results The mean age of the patients was 27 years (15-45), the gestational age was 29 (9.4-41) and the average length of stay was 5.7 days. Dry cough (66.6 percent), nasal congestion/secretion (57.5 percent) and headache (45.5 percent) were the most common symptoms. Six hundred twenty nine patients suffered complications (22.5 percent) being bronchopneumonia (12.6 percent) and persistent bronchial asthma (7.8 percent) the most common; additionally, the latter was the most frequent risk factor(12.6 percent). There were not deaths in this group of patients. Conclusions The epidemiological surveillance, the early diagnosis, the prompt and musticidisciplinary treatment in compliance with the set medical protocols in all cases were determining factors in the satisfactory results achieved in the fight against influenza A (H1N1) pandemic

Manifestações clínicas e evolução da infecção pelo vírus da influenza A (H1N1) em receptores de transplante renal / Clinical manifestations and evolution of infection by influenza A (H1N1) in kidney transplant recipients

INTRODUÇÃO: A emergência do surto pandêmico de influenza A, subtipo H1N1, em abril de 2009, representou um grande desafio para a logística de saúde pública. Embora a maioria dos pacientes infectados apresente manifestações clínicas e evolutivas muito semelhantes às observadas na influenza sazonal, um número significativo de indivíduos evolui com pneumonia e insuficiência respiratória aguda severa. O impacto da infecção pelo vírus influenza A, subtipo H1N1, em pacientes imunossuprimidos não é determinado. MÉTODOS: Neste estudo, foram analisadas a apresentação clínica e a evolução da influenza A, subtipo H1N1, em 19 receptores de transplante renal. Os pacientes receberam confirmação diagnóstica pela técnica de RT-PCR. O manejo clínico incluiu terapêutica antiviral com fosfato de oseltamivir e antibióticos. RESULTADOS: A população estudada foi predominantemente de indivíduos do sexo masculino (79 por cento), brancos (63 por cento), com idade média de 38,6 ± 17 anos e portadores de pelo menos uma comorbidade (53 por cento). A infecção por influenza A, subtipo H1N1, foi diagnosticada em média 41,6 ± 49,6 meses após o transplante. Os sintomas mais comuns foram: tosse (100 por cento), febre (84 por cento), dispneia (79 por cento) e mialgia (42 por cento). Disfunção aguda do enxerto foi observada em 42 por cento dos pacientes. Cinco pacientes (26 por cento) foram admitidos em Unidade de Terapia Intensiva, dois (10 por cento) necessitaram de suporte com ventilação invasiva e dois (10 por cento) receberam drogas vasoativas. A mortalidade foi de 10 por cento. CONCLUSÕES: A disfunção aguda do enxerto renal foi um achado frequente, e as características clínicas, laboratoriais e evolutivas foram comparáveis às da população geral.

INTRODUCTION: The emergence of the pan>demic outbreak of influenza A (H1N1) in April, 2009, represented a logistic challenge for public health. Although most infected patients presented clinical and evolutionary manifestations which were very similar to seasonal influenza, a significant number of individuals developed pneumonia and severe acute respiratory failure. The impact of influenza A (H1N1) in immunocompromised patients is not well established yet. METHODS: This study aimed to analyze the clinical presentations and evolution of influenza A (H1N1) in 19 kidney transplant recipients. Influenza A (H1N1) infection was confirmed by RT-PCR in all patients. Treatment included antiviral therapy with oseltamivir phosphate and antibiotics. RESULTS: The studied population was compounded mostly of white people (63 percent), males (79 percent), at a mean age of 38.6 ± 17 years and patients with at least one comorbidity (53 percent). Influenza A (H1N1) infection was identified 41.6 ± 49.6 months after transplantation. Common symptoms included cough (100 percent), fever (84 percent), dyspnea (79 percent), and myalgia (42 percent). Acute allograft dysfunction was observed in 42 percent of the patients. Five patients (26 percent) were admitted to the Intensive Care Unit, two (10 percent) required invasive ventilation support, and two (10 percent) required vasoactive drugs. Mortality rate was 10 percent. CONCLUSIONS: Acute renal allograft dysfunction was a common finding. Clinical, laboratory, and evolutionary characteristics were comparable to those in the general population.

Outcome of Pandemic H1N1 Pneumonia: Clinical and Radiological Findings for Severity Assessment

BACKGROUND/AIMS: Pandemic influenza A (H1N1) virus infection presents with variable severity. However, little is known about clinical predictors of disease severity. We studied the clinical predictors of severe pandemic H1N1 pneumonia and their correlation with radiological findings. METHODS: We reviewed medical and radiological records of adults with pandemic H1N1 pneumonia. After classification of patients into severe and non-severe groups, the following data were evaluated: demographic data, pneumonia severity index (PSI), CURB65, risk factors, time to first dose of antiviral medication, routine laboratory data, clinical outcome, and radiological characteristics. RESULTS: Of 37 patients with pandemic H1N1 pneumonia, 12 and 25 were assigned to the severe and non-severe groups, respectively. PSI score, serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dyhydrogenase (LDH) levels were higher in the severe group than in the non-severe group (p = 0.035, 0.0003, 0.0023, and 0.0002, respectively). AST, ALT, and LDH levels were positively correlated with the radiological findings (p < 0.0001, 0.0003, and < 0.0001, respectively) and with the number of involved lobes (p = 0.663, 0.0134, and 0.0019, respectively). The most common finding on high resolution computed tomography (HRCT) scans was ground-glass attenuation with consolidation (n = 22, 60%), which had a predominantly patchy distribution (n = 31). CONCLUSIONS: We demonstrated a positive correlation between clinical findings, such as serum AST, ALT, and LDH levels, and radiological findings. A combination of clinical and HRCT indicators would be useful in predicting the clinical outcome of pandemic H1N1 pneumonia.

Mongrelised genetics of H1N1 virus: A bird's eyeview.

H1N1 influenza, also known as "novel H1N1 virus" has led to a "global outcry." This virus is more virulent when compared with other seasonal flu viruses. Virulence may change as the adaptive mutation gene increases within the virus. A study at the US Centre for Disease Control and Prevention published in May 2009 found that children had no preexisting immunity to the new strain as they showed no cross-reactive antibody reaction when compared with adults aged 18-64 years, who showed a cross-reactive antibody reaction of 6-9% and older adults with 33% immunity. This review article depicts H1N1 virus, its virulence with genetic evolution potential and preventive protocol for the dental professionals. This would allow us to comprehend the changes in the disease process and contribute in its prevention as "prevention is better than cure."

Enteritis virales en adultos inmunocompetentes, agentes clásicos y emergentes / Viral enteritis in immunocompetent adults: classic and emergent agents

Objetivo: Revisar aspectos epidemiológicos y clínicos de las enteritis de etiología viral en pacientes adultos inmunocompetentes. Resumen: La diarrea aguda infecciosa (enteritis) es una patología relevante en todo el mundo y aún es responsable de una alta mortalidad en niños y elevada morbilidad en adultos. En pacientes adultos inmunocompetentes la etiología viral es frecuentemente subestimada aunque la mayoría de las enteritis agudas son causadas por virus. Los agentes virales más frecuentemente identificados son el Norovirus, Rotavirus, Astrovirus, y Adenovirus. Su principal vía de contagio es la ruta fecal-oral y el cuadro clínico suele ser en su gran mayoría leve y autolimitado, con manifestaciones clínicas similares e inespecíficas: diarrea acuosa, náuseas, vómitos y dolor abdominal. Adultos mayores y pacientes inmunosuprimidos pueden presentar cuadros más severos y prolongados. El tratamiento es fundamentalmente sintomático. La prevención se basa en tomar medidas sanitarias y limitar el contagio de persona a persona. Virus respiratorios emergentes como SARS e InfluenzaA-H1N1, con frecuencia comprometen el tracto gastrointestinal y en períodos de epidemia deben ser considerados en el diagnóstico diferencial de enteritis aguda.

Objective: To review epidemiological and clinical aspects of viral enteritis in immunocompetent adult patients. Abstract: Acute infectious diarrhea (enteritis) is a worldwide important disease and it still accounts for high mortality among children and high morbidity among adults. In immunocompetent adult patients the viral etiology is frequently underestimated, although the most common cause of acute enteritis is avirus. The mos frequently identified viral agents are Norovirus, Rotavirus, Astrovirus, and Adenovirus. The main mechanism of spread of the disease is fecal-oral transmission and the clinical setting is commonly mild and self-limited, with clinical manifestations that are similar and unspecific: aqueous diarrhea, nausea, vomiting and abdominal pain. Elderly and immunosupressed patients may show more severe and prolonged episodes. Treatment is mainly symptomatic. Prevention is based on taking sanitary measures and reducing person-to-person transmission. Emerging respiratory viruses as SARS and A-H1N1 influenza frequently compromise the gastrointestinal tract and during epidemic periods these viruses should be considered in differential diagnosis of acute enteritis.

The Spread of Pandemic H1N1 2009 by Age and Region and the Comparison among Monitoring Tools

This report describes the pattern of the spread of the pandemic H1N1 2009 and compares 3 monitoring tools until the 57th week or January 31, 2010. The 1st week was from December 28th, 2008 to January 3rd, 2009. A total of 740,835 patients were reported to be infected with pandemic H1N1 2009 and 225 patients were reported to have died of pandemic H1N1 2009. The number of patients aged from 7 to 12 was the largest (183,363 patients in total) but the virus spread and then was suppressed most quickly among the children between 13 and 18. The region-determinant incidence of patients showed diverse patterns according to regions. The peak of the ILI per thousand was at the 45th week, the number of antiviral prescriptions reached its peak at the 44th week, and the peak based on reported patients was the 46th week. As of February 3 2010, the outbreak passed through the peak and has gradually subsided. Now it is time for the government and the academic world to review this outbreak, efficacy of vaccination, and further preparation and response for the next pandemic.