Differential Leukocyte Expression of IFITM1 and IFITM3 in Patients with Severe Pandemic Influenza A(H1N1) and COVID-19.

Interferon-induced transmembrane (IFITM) proteins mediate protection against enveloped viruses by blocking membrane fusion at endosomes. IFITM1 and IFITM3 are crucial for protection against influenza, and various single nucleotide polymorphisms altering their function have been linked to disease susceptibility. However, bulk IFITM1 and IFITM3 mRNA expression dynamics and their correlation with clinical outcomes have not been extensively addressed in patients with respiratory infections. In this study, we evaluated the expression of IFITM1 and IFITM3 in peripheral leukocytes from healthy controls and individuals with severe pandemic influenza A(H1N1) or coronavirus disease 2019 (COVID-19). Comparisons between participants grouped according to their clinical characteristics, underlying disease, and outcomes showed that the downregulation of IFITM1 was a distinctive characteristic of severe pandemic influenza A(H1N1) that correlated with outcomes, including mortality. Conversely, increased IFITM3 expression was a common feature of severe pandemic influenza A(H1N1) and COVID-19. Using a high-dose murine model of infection, we confirmed not only the downregulation of IFITM1 but also of IFITM3 in the lungs of mice with severe influenza, as opposed to humans. Analyses in the comparative cohort also indicate the possible participation of IFITM3 in COVID-19. Our results add to the evidence supporting a protective function of IFITM proteins against viral respiratory infections in humans.

Influenciadores da desinformação nas pandemias de gripe espanhola e Covid-19: um estudo documental / Disinformation influencers in the spanish flu and covid-19 pandemics: a documentary study

Resumo: Introdução: Tão rápidas e destrutivas quanto a doença pandêmica,a propagação de inverdades em cenários de pandemias tem levado a muitas mortes. Para tanto, intervenções contrainfodêmicas são hoje um dos maiores desafios para o setor de saúde Objetivo: Este estudo teve como objetivo compreender as confluências da desinformação na gripe espanhola e na Covid-19 e como atuam os influenciadores de notícias falsas no campo da saúde brasileira. Método: Trata-se de estudo documental com abordagem qualitativa feita por meio da triangulação de dados em diferentes fontes e nos períodos da gripe espanhola (de 1918 a 1920) e da Covid-19 (de 2020 a 2021). Resultado: Observou-se que as pandemias foram e continuam cenários férteis para a produção e propagação dos influenciadores da desinformação e que se faz necessário problematizar os desafios da formação do trabalhador em tempos de modernidade líquida e em contextos de infodemias, já que os discursos profissionais têm sido fragilizados diante da desinformação. Conclusão: O estudo possibilitou compreender as confluências da desinformação entre a gripe espanhola e a Covid-19, e o papel da formação em saúde no enfrentamento da disseminação em massa de notícias falsas na saúde brasileira.

Abstract: Introduction: As fast and destructive as the pandemic disease is the spread of untruths in pandemic scenarios, which led to many deaths. Therefore, counter-infodemic interventions are currently one of the biggest challenges for the health sector. Objective: To understand the convergence of disinformation on the Spanish Flu and COVID-19 and how fake news influencers act in the Brazilian health field. Method: this is a documentary study with a qualitative approach, carried out through the triangulation of data from different sources and in the periods of the Spanish Influenza (1918 to 1920) and COVID-19 (2020 to 2021). Result: It was observed that the pandemics were and continue to be fertile scenarios for the production and dissemination of disinformation influencers and that it is necessary to problematize the challenges of worker training in times of liquid modernity and in contexts of infodemics, since the professional discourses have been weakened bydisinformation. Conclusion: the study allowed us to understand the convergence of disinformation between the Spanish Flu and COVID-19 and the role of health education when facing the mass dissemination of fake news in the Brazilian health field.

Lessons from the past in the present: news from the Spanish flu pandemic to COVID-19 / Lecciones del pasado en el presente: noticias de la pandemia de gripe española al COVID-19 / Lições do passado no presente: notícias da pandemia de gripe espanhola à Covid-19

ABSTRACT Objective: to analyze the health conducts for combating the Spanish flu and its relationship with the COVID-19 pandemic in Rio de Janeiro. Methods: study from the perspective of microhistory, with analysis of articles published in Revista da Semana on the Spanish flu, having as criteria publications with the term "epidemic" referring to the Spanish flu or influenza in the period of the epidemic outbreak in Rio de Janeiro, Federal District. Results: 18 records, organized in three thematic axes: political, 4; social, 11; care, 3, were found. Final considerations: the lessons left by the Spanish flu epidemic in coronavirus times will be changes in the political, social and care field as marks of major epidemics.

RESUMEN Objetivo: analizar la conducta sanitaria para combatir la gripe española y su relación con la pandemia COVID-19 en Río de Janeiro. Métodos: estudio desde la perspectiva de la microhistoria, con análisis de los artículos publicados en la Revista da Semana sobre la gripe española, utilizando como criterio las publicaciones con el término "epidemia" referida a la gripe española o influenza en el período de la epidemia y brote circunscrito en Río de Janeiro, Distrito Federal. Resultados: se encontraron 18 registros organizados en tres ejes temáticos: político, 4; social, 11; de atención, 3. Consideraciones finales: las lecciones dejadas por la epidemia de gripe española en tiempos de coronavirus serán los cambios en el ámbito político, social y asistencial como marcas de las grandes epidemias.

RESUMO Objetivo: analisar as condutas sanitárias para o combate da gripe espanhola e sua relação com a pandemia de COVID-19 no Rio de Janeiro. Métodos: estudo na perspectiva da micro-história, com análise de matérias publicadas na Revista da Semana sobre a gripe espanhola, tendo como critérios publicações com o termo "epidemia" referente à gripe espanhola ou à influenza no período do surto epidêmico e circunscrita no Rio de Janeiro, Distrito Federal. Resultados: foram encontrados 18 registros organizados em três eixos temáticos: político, 4; social, 11; de cuidados, 3. Considerações finais: as lições deixadas pela epidemia da gripe espanhola em tempos de coronavírus serão de mudanças no campo político, social e dos cuidados como marcas das grandes epidemias.

Clinical and Immunological Factors That Distinguish COVID-19 From Pandemic Influenza A(H1N1).

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), is a global health threat with the potential to cause severe disease manifestations in the lungs. Although COVID-19 has been extensively characterized clinically, the factors distinguishing SARS-CoV-2 from other respiratory viruses are unknown. Here, we compared the clinical, histopathological, and immunological characteristics of patients with COVID-19 and pandemic influenza A(H1N1). We observed a higher frequency of respiratory symptoms, increased tissue injury markers, and a histological pattern of alveolar pneumonia in pandemic influenza A(H1N1) patients. Conversely, dry cough, gastrointestinal symptoms and interstitial lung pathology were observed in COVID-19 cases. Pandemic influenza A(H1N1) was characterized by higher levels of IL-1RA, TNF-α, CCL3, G-CSF, APRIL, sTNF-R1, sTNF-R2, sCD30, and sCD163. Meanwhile, COVID-19 displayed an immune profile distinguished by increased Th1 (IL-12, IFN-γ) and Th2 (IL-4, IL-5, IL-10, IL-13) cytokine levels, along with IL-1ß, IL-6, CCL11, VEGF, TWEAK, TSLP, MMP-1, and MMP-3. Our data suggest that SARS-CoV-2 induces a dysbalanced polyfunctional inflammatory response that is different from the immune response against pandemic influenza A(H1N1). Furthermore, we demonstrated the diagnostic potential of some clinical and immune factors to differentiate both diseases. These findings might be relevant for the ongoing and future influenza seasons in the Northern Hemisphere, which are historically unique due to their convergence with the COVID-19 pandemic.

Pandemic non-adjuvanted influenza A H1N1 vaccine in a cohort of patients with systemic sclerosis

Abstract Objective To assess the possible effect of therapy, disease subtype and severity on H1N1 immunogenicity in patients with SSc. Methods Ninety-two patients and 92 age- and gender-matched healthy controls received adjuvant-free influenza A/California/7/2009 (pH1N1) vaccine. Blood samples were collected immediately before and 3 weeks after vaccination to evaluate antibody responses to the H1N1 virus. Efficacy was assessed by seroprotection (SP) and seroconversion (SC) rates and the factor increase in geometric mean antibody titre. Participants received a 21-day symptom diary card and were instructed to report local and systemic adverse events. Results SSc patients were predominantly females (91%) and 61% had limited SSc, 12% had severe skin involvement and 57.6% were on immunosuppressive (IS) therapy. SSc patients and controls presented comparable overall SP (P = 0.20) and SC (P = 0.61) rates. Further evaluation of the possible effect of disease and therapy revealed similar rates of SP and SC in patients with dcSSc vs lcSSc (SP P = 0.62 and SC P = 0.66), severe vs mild/moderate skin involvement (SP P = 1 and SC P = 0.45) and with vs without IS (SP P = 0.26 and SC P = 0.10). The frequency of mild local and minor systemic reactions was similar in patients with dcSSC vs lcSSc (P = 0.70 vs 0.32) and in those with and without severe skin involvement (P = 0.59 vs 0.28). Conclusion The non-adjuvanted influenza H1N1 virus vaccine proved to be safe and effective, independent of SSc clinical subtype, disease severity or therapy. These latter factors do not seem to contribute to mild adverse events observed in SSc. Our data support the annual influenza vaccination recommendation for these patients.

Post-pandemic influenza A (H1N1) 2009 virus infection in pregnant women in Ceará, Brazil.

OBJECTIVE: The aim of this study was to present results of the post-pandemic phase of A(H1N1)pdm09 virus infection in pregnant women in Ceará, Brazil, during the January-June 2012 influenza season. RESULTS: One hundred and fifty-four nasopharyngeal swab samples were collected from pregnant women admitted to hospitals with suspected severe acute respiratory infection (SARI). Fifty-three (34·4%) had laboratory-confirmed A(H1N1)pdm09 virus infection with 15 (28·3%) outpatients and 38 (71·7%) hospitalized. Five (9·4%) women were in the first trimester of pregnancy, 20 (37·7%) in the second trimester of pregnancy, and 24 (45·2%) in the third trimester of pregnancy. Three had no information about the time of pregnancy. Six samples from newborns were also analyzed, of which three were nasopharyngeal swab positive for A(H1N1)pdm09. These swabs were collected immediately after birth, with the exception of one that was collected on the day after birth. CONCLUSION: Our findings suggest that transplacental transfer of influenza viruses could occur as a result of severe illness in pregnancy. It is therefore important to encourage women to be vaccinated against influenza in order to avoid pregnancy complications.

Circulating levels of miR-150 are associated with poorer outcomes of A/H1N1 infection.

BACKGROUND: Overproduction of pro-inflammatory cytokines and chemokines is frequently associated with severe clinical manifestations in patients infected with influenza A/H1N1 virus. Micro-RNAs (miRNAs) are highly conserved small non-coding RNA molecules that post-transcriptionally regulate gene expression and are potential biomarkers and therapeutic targets in different inflammatory conditions. METHODS: We studied the circulating and miRNA profiles in critically ill A/H1N1 patients, A/H1N1 patients with milder disease, asymptomatic housemates and healthy controls. Cytokine, chemokine and growth factors that were potential targets of differentially expressed miRNAs were assessed. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment and interactome analysis of these miRNAs were also performed. RESULTS: Critically ill patients exhibited a significant over-expression of circulating miR-150 (p<0.005) when compared to patients with milder disease. miR-29c, miR-145 and miR-22 were differentially expressed in patients with severe A/H1N1 disease whereas miR-210, miR-126 and miR-222 were downregulated in individuals exposed to the A/H1N1 virus. Significant correlations (p<0.05) between circulating levels of miR-150 with IL-1ra, IL-2, IL-6, CXCL8, IFN-γ, CXCL10 and G-CSF were detected, particularly in critically ill patients. CONCLUSION: The up-regulation of miR-150 is associated with poorer outcomes of A/H1N1 infection. The differential expression of miRNAs related with immune processes in severe A/H1N1 disease supports the potential role of these miRNAs as biomarkers of disease progression.

Influenza A H1N1pdm 2009 Virus in Paraguay: Nucleotide Point Mutations in Hemagglutinin and Neuraminidase Genes are not Associated with Drug Resistance.

Influenza virus is associated with upper respiratory tract infections. The fourth influenza pandemic was declared in 2009. The aim of this study was to determine the genetic variability of the 2009 H1N1 pandemic virus circulating in Paraguay. Nasal swabs were collected from 181 patients with flu symptoms managed at the Hospital of the Medical School in Asunción, Paraguay, between August and October 2009. Virus detection was carried out by real-time reverse transcription-polymerase chain reaction, followed by sequencing of the hemagglutinin and neuraminidase genes, and phylogenetic analysis. H1N1pdm09 was detected in 14.9% (27/181) of the suspected cases. Analysis of 13 samples showed that these viruses the clustered in a single genetic group. Neither the mutation related to exacerbation of disease (D239G in hemagglutinin) nor that related to antiviral resistance (H275Y in neuraminidase), both detected in neighboring countries, were found. This genetic analysis of H1N1pdm09 will help to understand the spread of the disease.

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.

Pandemic influenza A (H1N1) 2009 in the English- and Dutch-speaking Caribbean an epidemiological overview / Pandemia de gripe A (H1N1) de 2009 en el Caribe de habla inglesa y holandesa: panorama epidemiológico

OBJECTIVE: To describe epidemiological trends of pandemic influenza A (H1N1) in the English- and Dutch-speaking Caribbean during the pandemic period. DESIGN AND METHODS: Data on laboratory-confirmed cases and deaths associated with pandemic influenza A (H1N1) contained in two regional databases at the Caribbean Epidemiology Centre (CAREC) were analysed. The data sources were epidemiological and laboratory reports from English- and Dutch-speaking countries and the CAREC laboratory information system (LABIS). RESULTS: In the English- and Dutch-speaking Caribbean, pandemic influenza A (H1N1) was the predominant circulating influenza virus type during the pandemic period. There were three distinct phases: a first pandemic wave during mid-April to end of August 2009 (734 cases), a second pandemic wave during September-December 2009 (570 cases) and a phase of low transmission during January to mid-August 2010 (55 cases). The majority of cases (76%) were aged less than 30 years, with children of school age being most affected. Most cases (89%) presented with symptoms of the respiratory tract and smaller proportions (20-40%) presented with gastrointestinal and other symptoms. No cases tested were resistant to oseltamivir. A quarter of cases required hospitalization and the case fatality rate was 1.8%. CONCLUSIONS: The epidemiological characteristics of the pandemic in the English- and Dutch-speaking Caribbean were consistent with that in other parts of the world. It is important that post pandemic surveillance (epidemiological and virological) for respiratory illnesses continues to be enhanced in order to give a better understanding of seasonality and changing trends in respiratory illnesses and their aetiologic agents.

OBJETIVO: Describir las tendencias epidemiológicas de la pandemia de gripe A (H1N1) en el Caribe de habla inglesa y holandesa durante el periodo pandémico. DISEÑO Y MÉTODOS: Se analizaron los datos sobre casos confirmados por laboratorio y muertes asociadas con la pandemia de gripe A (H1N1), contenidos en dos bases de datos regionales del Centro Epidemiológico del Caribe (CAREC). Las fuentes de los datos fueron los reportes epidemiológicos y de laboratorio de los países de habla inglesa y holandesa, así como del Sistema de Información de Laboratorio del CAREC (LABIS). RESULTADOS: En el Caribe anglófono y de habla holandesa, la pandemia de gripe A (H1N1) fue el tipo de virus de gripe que circuló predominante durante el periodo pandémico. Hubo tres fases distintas: una primera ola pandémica desde mediados de abril a finales de agosto de 2009 (734 casos); una segunda ola pandémica en septiembre-diciembre de 2009 (570 casos); y una fase de baja transmisión de enero a mediados de agosto de 2010 (55 casos). La mayoría de los casos (76%) tenían menos de 30 años, siendo los niños de edad escolar los más afectados. La mayor parte de los casos (89%) presentaban síntomas de las vías respiratorias, y un número menor (20-40%) presentaban síntomas gastrointestinales y otros síntomas. Ninguno de los casos sometidos a prueba resultó resistente al oseltamivir. Una cuarta parte de los casos requirió hospitalización, y la tasa de letalidad fue de 1.8%. CONCLUSIONES: Las características epidemiológicas de la pandemia en el Caribe de habla inglesa y holandesa concuerdan con las encontradas en otras partes del mundo. Es importante continuar mejorando la vigilancia postpandémica (epidemiológica y virológica) de las enfermedades respiratorias, con el fin de lograr una mejor comprensión de la estacionalidad y las tendencias cambiantes de las enfermedades respiratorias y sus agentes etiológicos.

Spontaneous reporting of adverse events following pandemic influenza A (H1N1) immunization in a reference center in the State of Sao Paulo, Brazil

Introduction This paper describes adverse events (AEs) temporally associated to the pandemic influenza A (H1N1) vaccine observed in a reference center in São Paulo, Brazil, during a 2010 mass vaccination campaign. Methods A retrospective study involving persons who sought medical care for AEs following influenza vaccination. Data were retrieved from medical records, vaccine AE notification forms, and a computerized system for immunobiological registration. Results Sixty-six vaccinees sought medical care for AEs after immunization. The most frequent AEs were fever, headache, myalgia, and pain at the injection site. No serious AEs were reported. Conclusions Few vaccinees spontaneously reported AEs to influenza A (H1N1) vaccine at this center. .

Pandemic influenza A (H1N1) 2009: epidemiological analysis of cases in a tropical/semi-arid region of Brazil

Introduction The year 2009 marked the beginning of a pandemic caused by a new variant of influenza A (H1N1). After spreading through North America, the pandemic influenza virus (H1N1) 2009 spread rapidly throughout the world. The aim of this study was to describe the clinical and epidemiological characteristics of cases of pandemic influenza in a tropical/semi-arid region of Brazil. Methods A retrospective study analyzed all suspected cases of pandemic influenza (H1N1) 2009 reported in the Ceará State through the National Information System for Notifiable Diseases during the pandemic period between 28 April, 2009 and November 25, 2010. Results A total of 616 suspected cases were notified, 58 (9.4%) in the containment phase and 558 (90.6%) in the mitigation phase. Most cases were of affected young people resident in the City of Fortaleza, the largest urban center in the State of Ceará. The most frequent symptoms presented by the cases with confirmed infection were fever, cough, myalgia, arthralgia, and nasal congestion. Mortality rate was 0.0009/1,000 inhabitants and lethality was 5.6%. Deaths were observed only in the mitigation phase. Mortality rates were similar for both sexes but were higher in the age group under 5 years. Conclusions The study suggests that the influenza A (H1N1) pandemic in this tropical/semi-arid region had a lower magnitude when compared to states in the Southern and Southeastern regions of Brazil. .

The characteristics, clinical manifestations and outcomes of pandemic influenza A (H1N1) 2009 in the elderly

Introduction The objetctive of this study was to evaluate the 2009 Pandemic Influenza A (H1N1) in the elderly and identify the clinical characteristics, mortality and prognostic factors of the infection in these patients. Methods This was an observational, retrospective study. Data were collected from the National Notifiable Diseases (SINAN), from the Brazilian Ministry of Health. Only patients 60 years old or more that had laboratory confirmed infections were included. The socio-demographic and clinical variables and outcomes were evaluated to compare mortality rates in the presence or absence of these factors. Results We included 93 patients in the study, 16.1% of whom died. The symptoms of cough and dyspnea, the use of the antiviral oseltamivir, influenza vaccine and comorbidities influenced the outcomes of cure or death. Chest radiography can aid in diagnosis. Conclusions Although relatively few elderly people were infected, this population presented high lethality that can be justified by the sum of clinical, physical and immunological factors in this population. Treatment with oseltamivir and vaccination against seasonal influenza have significantly reduced rates of hospitalization and mortality. .

Trends of influenza infection in Suriname.

The trends of influenza infection in Suriname were assessed from February 2010 through February 2011. Testing of 393 patients with symptoms of acute respiratory infection (ARI) revealed 15.3% Influenza B and 18.6% could be identified as influenza A positive, consisting of 56% influenza A(H1N1)pdm09 and 44% seasonal A(H3N2). Influenza infection occurred throughout the year, and all three influenza types affected young children as the primary population. The annual incidence of A(H1N1)pdm09 was 6.88 per 100,000 inhabitants [CI] 4.87-9.45. The spread of influenza could neither be linked to tourist flow from the Netherlands nor to contact rates related to school schedules.

Genome Stability of Pandemic Influenza A (H1N1) 2009 Based on Analysis of Hemagglutinin and Neuraminidase Genes.

Influenza A virus (H1N1), which arose in 2009, constituted the fourth pandemic after the cases of 1918, 1957, and 1968. This new variant was formed by a triple reassortment, with genomic segments from swine, avian, and human influenza origins. The objective of this study was to analyze sequences of hemagglutinin (n=2038) and neuraminidase (n=1273) genes, in order to assess the extent of diversity among circulating 2009-2010 strains, estimate if these genes evolved through positive, negative, or neutral selection models of evolution during the pandemic phase, and analyze the worldwide percentage of detection of important amino acid mutations that could enhance the viral performance, such as transmissibility or resistance to drugs. A continuous surveillance by public health authorities will be critical to monitor the appearance of new influenza variants, especially in animal reservoirs such as swine and birds, in order to prevent the potential animal-human transmission of viruses with pandemic potential.

Isolation and characterization of a pandemic H1N1 influenza virus in pigs in Brazil / Isolamento e caracterização do vírus da influenza pandêmico H1N1 em suínos no Brasil

Influenza A virus (IAV) infections are endemic in pork producing countries around the world. The emergence of the pandemic 2009 human H1N1 influenza A virus (pH1N1) raised questions about the occurrence of this virus in Brazilian swine population. During a 2009-2010 swine influenza virus research project at Embrapa Swine and Poultry (CNPSA), an outbreak of a highly transmissible H1N1 influenza A virus disease was detected in a pig herd in Santa Catarina State, Brazil. The virus caused a mild disease in growing pigs and sows without mortality. Three clinically affected piglets were euthanized. Gross lesions included mild to moderate consolidation of cranioventral areas of the lung. Microscopically, the lesions were characterized by necrotizing obliterative bronchiolitis and bronchointerstitial pneumonia. Immunohistochemistry using a monoclonal antibody against type A influenza virus nucleoprotein revealed positive staining in the nuclei of the bronchiolar epithelial cells. Lung tissue from three piglets and nasal swabs from five sows and four piglets were positive for influenza A by RT-PCR. Influenza virus was isolated from one lung, later confirmed by the hemagglutination test (HA titer 1:128) and RT-PCR. Sequence analyses of Hemmaglutinin (HA) and Matrix (M) genes revealed that the virus was consistent with the pandemic (A/H1N1) 2009 influenza virus strain that circulated in humans. This is the first report of an outbreak of pandemic A/H1N1 influenza virus in pigs in Brazil.

A infecção causada pelo vírus Influenza A (IAV) é endêmica em suínos no mundo inteiro. O surgimento da pandemia de influenza humana pelo vírus A/H1N1 (pH1N1) em 2009 levantou dúvidas sobre a ocorrência deste vírus em suínos no Brasil. Durante o desenvolvimento de um projeto de pesquisa do vírus de influenza suína em 2009-2010, na Embrapa Suínos e Aves (CNPSA), foi detectado em um rebanho de suínos em Santa Catarina, Brasil, um surto de influenza altamente transmissível causado pelo subtipo viral H1N1. Este vírus causou uma doença leve em suínos em crescimento e em fêmeas adultas, sem mortalidade. Tres leitões clinicamente afetados foram eutanasiados. As lesões macroscópicas incluiam consolidação leve a moderada das áreas cranioventrais do pulmão. Microscopicamente, as lesões foram caracterizadas por bronquiolite necrosante obliterativa e pneumonia broncointersticial. A imunohistoquímica, utilizando um anticorpo monoclonal contra a nucleoproteína do vírus influenza A, revelou marcação positiva no núcleo das células epiteliais bronquiolares. O tecido pulmonar de três leitões e os suabes nasais de cinco fêmeas e quatro leitões foram positivos para influenza A pela RT-PCR. O vírus influenza foi isolado de um pulmão, mais tarde sendo confirmado pelo teste de hemaglutinação (título HA 1:128) e por RT-PCR. A análise das seqüências de nucleotídeos dos genes da hemaglutinina (HA) e proteína da matriz (M) revelou que o vírus isolado foi consistente com o vírus pandêmico A/H1N1/2009 que circulou em humanos no mesmo período. Este é o primeiro relato de um surto de influenza causado pelo vírus pandêmico A/H1N1 em suínos no Brasil.

Isolation and characterization of a pandemic H1N1 influenza virus in pigs in Brazil / Isolamento e caracterização do vírus da influenza pandêmico H1N1 em suínos no Brasil

Influenza A virus (IAV) infections are endemic in pork producing countries around the world. The emergence of the pandemic 2009 human H1N1 influenza A virus (pH1N1) raised questions about the occurrence of this virus in Brazilian swine population. During a 2009-2010 swine influenza virus research project at Embrapa Swine and Poultry (CNPSA), an outbreak of a highly transmissible H1N1 influenza A virus disease was detected in a pig herd in Santa Catarina State, Brazil. The virus caused a mild disease in growing pigs and sows without mortality. Three clinically affected piglets were euthanized. Gross lesions included mild to moderate consolidation of cranioventral areas of the lung. Microscopically, the lesions were characterized by necrotizing obliterative bronchiolitis and bronchointerstitial pneumonia. Immunohistochemistry using a monoclonal antibody against type A influenza virus nucleoprotein revealed positive staining in the nuclei of the bronchiolar epithelial cells. Lung tissue from three piglets and nasal swabs from five sows and four piglets were positive for influenza A by RT-PCR. Influenza virus was isolated from one lung, later confirmed by the hemagglutination test (HA titer 1:128) and RT-PCR. Sequence analyses of Hemmaglutinin (HA) and Matrix (M) genes revealed that the virus was consistent with the pandemic (A/H1N1) 2009 influenza virus strain that circulated in humans. This is the first report of an outbreak of pandemic A/H1N1 influenza virus in pigs in Brazil.(AU)

A infecção causada pelo vírus Influenza A (IAV) é endêmica em suínos no mundo inteiro. O surgimento da pandemia de influenza humana pelo vírus A/H1N1 (pH1N1) em 2009 levantou dúvidas sobre a ocorrência deste vírus em suínos no Brasil. Durante o desenvolvimento de um projeto de pesquisa do vírus de influenza suína em 2009-2010, na Embrapa Suínos e Aves (CNPSA), foi detectado em um rebanho de suínos em Santa Catarina, Brasil, um surto de influenza altamente transmissível causado pelo subtipo viral H1N1. Este vírus causou uma doença leve em suínos em crescimento e em fêmeas adultas, sem mortalidade. Tres leitões clinicamente afetados foram eutanasiados. As lesões macroscópicas incluiam consolidação leve a moderada das áreas cranioventrais do pulmão. Microscopicamente, as lesões foram caracterizadas por bronquiolite necrosante obliterativa e pneumonia broncointersticial. A imunohistoquímica, utilizando um anticorpo monoclonal contra a nucleoproteína do vírus influenza A, revelou marcação positiva no núcleo das células epiteliais bronquiolares. O tecido pulmonar de três leitões e os suabes nasais de cinco fêmeas e quatro leitões foram positivos para influenza A pela RT-PCR. O vírus influenza foi isolado de um pulmão, mais tarde sendo confirmado pelo teste de hemaglutinação (título HA 1:128) e por RT-PCR. A análise das seqüências de nucleotídeos dos genes da hemaglutinina (HA) e proteína da matriz (M) revelou que o vírus isolado foi consistente com o vírus pandêmico A/H1N1/2009 que circulou em humanos no mesmo período. Este é o primeiro relato de um surto de influenza causado pelo vírus pandêmico A/H1N1 em suínos no Brasil.(AU)

Demand for care and nosocomial infection rate during the first influenza AH1N1 2009 virus outbreak at a referral hospital in Mexico City / Demanda asistencial y tasa de infección nosocomial durante el primer brote de influenza AH1N1 2009 en un hospital de referencia en la Ciudad de México

OBJECTIVE: Comparison of routine hospital indicators (consults at the Emergency Room (ER) and hospital admissions) during the 2009 pandemic of the influenza AH1N1 virus at the national referral hospital for respiratory diseases in Mexico City. MATERIAL AND METHODS: The outbreak was from April to mid-May 2009 and two control periods were used:2009 (before and after the outbreak),and during April-May from 2007 and 2008. RESULTS: During the outbreak total consultation at the ER increased six times compared with the 2007-2008 control period and 11 times compared with the 2009 control period. Pneumonia- or influenza-related ER consultations increased 23.2 and 15.3 percent, respectively. The rate of nosocomial infection during the outbreak was 13.6 and that of nosocomial pneumonia was 6 per/100 hospital discharges, a two-fold and three-fold increase compared to the control periods respectively. CONCLUSIONS: During the outbreak,mean severity of admitted patients increased,with a rise in in-hospital mortality and nosocomial infections rate, including nosocomial pneumonia.

OBJETIVO: Comparación de indicadores hospitalarios de rutina (consultas de urgencia, admisiones hospitalarias etc.) durante la pandemia de influenzaAH1N1 2009 en un hospital de referencia para enfermedades respiratorias de la Ciudad de México. MATERIAL Y MÉTODOS: El brote se consideró de abril a la mitad de mayo de 2009 y se comparó con dos periodos control: el de 2009 (antes y después del brote), y durante abril y mayo de 2007 y 2008. RESULTADOS: Durante el brote las consultas de urgencia crecieron seis veces comparadas con el periodo control 2007-2008 y 11 veces contra el periodo control de 2009. Las consultas por neumonía o influenza incrementaron 23.2 y 15.3 por ciento comparadas contra los periodos control, respectivamente. La tasa de infección nosocomial durante el brote fue de 13.6 y la de neumonía nosocomial de 6.0 por 100 egresos hospitalarios, el doble y el triple de la documentada en los periodos control respectivamente. CONCLUSIONES: Durante el brote, la gravedad promedio de los pacientes hospitalizados se incrementó, desencadenando un aumento en la mortalidad hospitalaria y en la tasa de infecciones nosocomiales, incluyendo la de neumonía nosocomial.

Estrategia cubana de caracterización molecular del virus influenza A/H1N1pdm / Cuban strategy for the molecular characterization of the pandemic influenza A virus (H1N1)

INTRODUCCIÓN: en Abril de 2009 se identificó una variante del virus influenza A/H1N1 de origen porcino, lo cual determinó que fuese declarada rápidamente la primera pandemia del siglo XXI. OBJETIVO: establecer una estrategia de secuenciación nucleotídica que permitiera diagnosticar diferencialmente los virus influenza A estacionales del nuevo virus pandémico, así como obtener la mayor cantidad de información posible desde el punto de vista molecular de los genes hemaglutinina y neuraminidasa, tanto de pacientes que sufrieron una enfermedad tipo influenza como los que padecieron de una infección respiratoria aguda grave y los que fallecieron. MÉTODOS: se diseñaron e implementaron tres estrategias de secuenciación que brindaron información importante acerca del nuevo virus en Cuba. RESULTADOS: a través de la tercera estrategia se obtuvieron los resultados más completos: diagnóstico diferencial, vigilancia de las mutaciones D222G/E en la hemaglutinina y las variantes virales H275Y resistentes al Tamiflu. A pesar de no haber detectado las mutaciones mencionadas, no se puede descartar su presencia en población cubana, debido a que estas estrategias no fueron diseñadas con ese fin. Se impone diseñar un estudio para cumplir con ese objetivo. CONCLUSIONES: las estrategias de secuenciación aplicadas en nuestro algoritmo permitieron realizar el diagnóstico diferencial de los virus influenza estacional del pandémico y su caracterización molecular (AU)

INTRODUCTION: in April 2009, there was identified a variant of the A/H1N1 influenza virus of swine origin, and shortly after the first pandemic in XXI century was declared. OBJECTIVES: to establish a nucleotide sequencing strategy for the differential diagnosis of the seasonal and pandemic influenza A viruses, and to obtain as much molecular information as possible about hemagglutinin and neuraminidase genes in patients with influenza-like illnesses, in those with severe respiratory infection and in patients who died. METHODS: three sequencing strategies were designed and implemented, which also offered important information about the new virus in Cuba. RESULTS: the third strategy provided the most comprehensive results such as differential diagnosis, the surveillance of the D222G/E mutation in hemagglutinin and Tamiflu-resistant H275Y viral variants. In spite of the fact that the mentioned mutations were not detected, their presence in the Cuban population can not be ignored since these strategies were not designed for this end. It is imperative to design a study to fulfill this objective. CONCLUSIONS: the sequencing strategies in our algorithm allowed the differential diagnosis of the seasonal and the pandemic viruses, and their molecular characterization (AU)

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 integr...(AU)

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 ...(AU)