Influenza and respiratory syncytial virus in infants study (IRIS) of hospitalized and non-ill infants aged <1 year in four countries: study design and methods.

BACKGROUND: This multi-country prospective study of infants aged <1 year aims to assess the frequency of influenza virus and respiratory syncytial virus (RSV) infections associated with hospitalizations, to describe clinical features and antibody response to infection, and to examine predictors of very severe disease requiring intensive care. METHODS/DESIGN: We are enrolling a hospital-based cohort and a sample of non-ill infants in four countries (Albania, Jordan, Nicaragua, and the Philippines) using a common protocol. We are currently starting year 2 of a 2- to 3-year study and will enroll approximately 3,000 infants hospitalized for any acute illness (respiratory or non-respiratory) during periods of local influenza and/or RSV circulation. After informed consent and within 24 h of admission, we collect blood and respiratory specimens and conduct an interview to assess socio-demographic characteristics, medical history, and symptoms of acute illness (onset ≤10 days). Vital signs, interventions, and medications are documented daily through medical record abstraction. A follow-up health assessment and collection of convalescent blood occurs 3-5 weeks after enrollment. Influenza and RSV infection is confirmed by singleplex real time reverse transcriptase polymerase chain reaction (rRT-PCR) assays. Serologic conversion will be assessed comparing acute and convalescent sera using hemagglutination inhibition assay for influenza antibodies and enzyme-linked immunosorbent assay (ELISA) for RSV. Concurrent with hospital-based enrollment, respiratory specimens are also being collected (and tested by rRT-PCR) from approximately 1,400 non-ill infants aged <1 year during routine medical or preventive care. DISCUSSION: The Influenza and RSV in Infants Study (IRIS) promises to expand our knowledge of the frequency, clinical features, and antibody profiles of serious influenza and RSV disease among infants aged <1 year, quantify the proportion of infections that may be missed by traditional surveillance, and inform decisions about the potential value of existing and new vaccines and other prevention and treatment strategies.

A study on the epidemiology and aetiology of acute gastroenteritis in adult patients presenting at the infectious diseases hospital in tirana, Albania.

BACKGROUND: Acute gastroenteritis remains a common cause of hospital emergency room visits in Albania. However, the aetiology of severe gastroenteritis leading to hospitalization in adults frequently remains unclear. AIMS: Our objective was to study the epidemiology and causes of community-acquired, acute gastroenteritis in adult patients presenting to hospital. STUDY DESIGN: Cross sectional study. METHODS: A prospective study was conducted from January 2010 to January 2012, among patients ≥15 years old with community-acquired gastroenteritis presenting to the emergency room of the University Hospital "Mother Theresa" in Tirana, Albania. Stool samples and rectal swabs were collected from the patients for microbiological testing. RESULTS: The median age of the study patients was 33 (15-88) years and 577 (58%) were females. The median age of males was 35 (15-87) years. The vast majority of cases occurred in urban area (849, 85%), p<0.01. Patients were admitted throughout the year with peak admissions for patients infected by bacterial pathogens in summer and those affected by viral pathogens in autumn. A total of 917 (91.7%) patients underwent a laboratory examination. The overall isolation rate was 51%. Bacterial pathogens were found in 29%, viral pathogens in 19% and protozoal pathogens in 2.5% of patients. No aetiological agent or other cause of acute diarrhoea was found in 449 (49%) patients. Twenty-nine (3.2%) patients were hospitalized. CONCLUSION: Despite extensive laboratory investigations, enteropathogens were detected in only 51% of adult patients who presented to the hospital ER with acute gastroenteritis. Viral infections ranked as the second most common cause of gastroenteritis in adults.

Suspected Crimean Congo Haemorrhagic Fever cases in Albania.

During 2003 to 2006 samples from 34 Albanian patients with suspected Crimean Congo Hemorrhagic Fever (CCHF) were tested by serology and PCR for CCHF virus; negative samples were further tested for hantaviruses, Leptospira spp. and Rickettsia spp. CCHF virus was detected in 38.2% of cases, hantaviruses in 11.7%, and leptospirosis and rickettsiosis were diagnosed in 29.4% and 2.9% of cases, respectively. There is a seasonal and clinical overlapping among the 4 diseases in Albania, suggesting that testing for these agents is necessary in cases with fever and haemorrhagic manifestations.

Molecular epidemiology of rotavirus in Central and Southeastern Europe.

A surveillance network was implemented by the Istituto Superiore di Sanità of Rome in collaboration with laboratories of virology in Czech Republic, Slovenia, Croatia, Albania, and Bulgaria. About 1,500 rotavirus-positive stool samples were collected from children with severe gastroenteritis admitted to hospitals or outpatient wards between 2004 and 2006. The G and P genotypes were determined by reverse transcription-nested PCR. Significant differences were found in the geographical distributions of rotavirus genotypes between countries participating in the study. The prevalence of "common" G/P combinations, G1P[8], G3P[8], G4P[8], and G2P[4], ranged between 50 and 85%. The G9 genotype, which is emerging worldwide, was identified in 2 to 35% of all samples depending on the country. Unusual combinations, such as G1 or G4 associated with P[4] or G2 with P[8], which may have arisen by reassortment between human strains, were found in samples from 3 to 20% of patients. The uncommon genotypes G8P[8] and G10P[6], which may have an animal origin, were also identified. Double infections with two rotavirus strains were observed in between 1.7 and 14% of cases studied. Our findings might implicate challenges for rotavirus vaccine implementation in a wide geographic area of the Balkans and Central-Eastern Europe and underscore the importance of extensive strain surveillance for success in vaccine development.