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Ram Purakayastha D, Vishnubhatla S, Rai SK, Broor S, Krishnan A. Estimation of Burden of Influenza among under-Five Children in India: A Meta-Analysis. J Trop Pediatr 2018; 64:441-453. [PMID: 29112737 DOI: 10.1093/tropej/fmx087] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND We estimated the burden of influenza-related acute respiratory tract infection (ARI) among under-fives in India through meta-analysis. METHODOLOGY We estimated pooled incidence and proportional positivity of laboratory-diagnosed influenza among under-fives using data from observational studies published from 1 January 1961 to 31 December 2016. Death due to influenza was estimated using a multiplier model. RESULTS Influenza-associated ARI incidence was estimated as 132 per 1000 child-years (115-149). The patients positive for influenza among ARI in outpatients and inpatients were estimated to be 11.2% (8.8-13.6) and 7.1% (5.5-8.8), respectively. We estimated total influenza cases during 2016 as 16 009 207 (13 942 916-18 082 769) in India. Influenza accounted for 10 913 476 (9 504 666-12 362 310) outpatient visits and 109 431 (83 882-134 980) hospitalizations. A total of 27 825 (21 382-34 408) influenza-associated under-five deaths were estimated in India in 2016. CONCLUSION Influenza imposes a substantial burden among under-fives in India. Public health approach for its prevention and control needs to be explored.
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Affiliation(s)
- Debjani Ram Purakayastha
- Centre for Community Medicine, All India Institute of Medical Sciences, AIIMS Campus, Ansari Nagar East, New Delhi, India
| | - Sreenivas Vishnubhatla
- Department of Biostatistics, All India Institute of Medical Sciences, AIIMS Campus, Ansari Nagar East, New Delhi, India
| | - Sanjay Kumar Rai
- Centre for Community Medicine, All India Institute of Medical Sciences, AIIMS Campus, Ansari Nagar East, New Delhi, India
| | - Sobha Broor
- Department of Microbiology, Faculty of Medicine and health Sciences, SGT University, Chandu-Budhera, Gurugram-Badli Road, Gurgaon, Haryana, India
| | - Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, AIIMS Campus, Ansari Nagar East, New Delhi, India
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Sahu M, Singh N, Shukla MK, Potdar VA, Sharma RK, Sahare LK, Ukey MJ, Barde PV. Molecular and epidemiological analysis of pandemic and post-pandemic influenza A(H1N1)pdm09 virus from central India. J Med Virol 2017; 90:447-455. [PMID: 29073730 DOI: 10.1002/jmv.24982] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 10/24/2017] [Indexed: 02/05/2023]
Abstract
Influenza A(H1N1)pdm09 virus pandemic struck India in 2009 and continues to cause outbreaks in its post-pandemic phase. Diminutive information is available about influenza A(H1N1)pdm09 from central India. This observational study presents epidemiological and molecular findings for the period of 6 years. Throat swab samples referred from districts of Madhya Pradesh were subjected to diagnosis of influenza A(H1N1)pdm09 following WHO guidelines. Clinical and epidemiological data were recorded and analyzed. Hemagglutinin (HA) gene sequencing and phylogenetic analysis were performed. The H275Y mutation responsible for antiviral resistance was tested using allelic real-time RT-PCR. Out of 7365 tested samples, 2406 (32.7%) were positive for influenza A(H1N1)pdm09, of which 363 (15.08%) succumbed to infection. Significant trends were observed in positivity (χ2 = 50.8; P < 0.001) and mortality (χ2 = 24.4; P < 0.001) with increasing age. Mutations having clinical and epidemiological importance were detected. Phylogenetic analysis of HA gene sequences revealed that clade 7, 6A, and 6B viruses were in circulation. Oseltamivir resistance was detected in three fatal cases. Influenza A(H1N1)pdm09 viruses having genetic diversity were detected from central India and continues to be a concern for public health. This study highlights the need of year-round monitoring by establishment of strong molecular and clinical surveillance program.
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Affiliation(s)
- Mahima Sahu
- National Institute for Research in Tribal Health (NIRTH), ICMR, Jabalpur, Madhya Prdesh, India
| | - Neeru Singh
- National Institute for Research in Tribal Health (NIRTH), ICMR, Jabalpur, Madhya Prdesh, India
| | - Mohan K Shukla
- National Institute for Research in Tribal Health (NIRTH), ICMR, Jabalpur, Madhya Prdesh, India
| | | | - Ravendra K Sharma
- National Institute for Research in Tribal Health (NIRTH), ICMR, Jabalpur, Madhya Prdesh, India
| | - Lalit Kumar Sahare
- National Institute for Research in Tribal Health (NIRTH), ICMR, Jabalpur, Madhya Prdesh, India
| | - Mahendra J Ukey
- National Institute for Research in Tribal Health (NIRTH), ICMR, Jabalpur, Madhya Prdesh, India
| | - Pradip V Barde
- National Institute for Research in Tribal Health (NIRTH), ICMR, Jabalpur, Madhya Prdesh, India
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Cowling BJ, Xu C, Tang F, Zhang J, Shen J, Havers F, Wendladt R, Leung NH, Greene C, Iuliano AD, Shifflett P, Song Y, Zhang R, Kim L, Chen Y, Chu DK, Zhu H, Shu Y, Yu H, Thompson MG. Cohort profile: the China Ageing REespiratory infections Study (CARES), a prospective cohort study in older adults in Eastern China. BMJ Open 2017; 7:e017503. [PMID: 29092901 PMCID: PMC5695487 DOI: 10.1136/bmjopen-2017-017503] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 08/24/2017] [Accepted: 08/29/2017] [Indexed: 12/19/2022] Open
Abstract
PURPOSE This study was established to provide direct evidence on the incidence of laboratory-confirmed influenza virus and respiratory syncytial virus (RSV) infections in older adults in two cities in Jiangsu Province, China, and the potential impact of acute respiratory infections on frailty. PARTICIPANTS The cohort was enrolled in Suzhou and Yancheng, two cities in Jiangsu Province in Eastern China. Between November 2015 and March 2016, we enrolled 1532 adults who were 60-89 years of age, and collected blood samples along with baseline data on demographics, general health, chronic diseases, functional status and cognitive function through face-to-face interviews using a standardised questionnaire. Participants are being followed weekly throughout the year to identify acute respiratory illnesses. We schedule home visits to ill participants to collect mid-turbinate nasal and oropharyngeal swabs for laboratory testing and detailed symptom information for the acute illness. Regular follow-up including face-to-face interviews and further blood draws will take place every 6-12 months. FINDINGS TO DATE As of 3 September 2016, we had identified 339 qualifying acute respiratory illness events and 1463 (95%) participants remained in the study. Laboratory testing is ongoing. FUTURE PLANS We plan to conduct laboratory testing to estimate the incidence of influenza virus and RSV infections in older adults. We plan to investigate the impact of these infections on frailty and functional status to determine the association of pre-existing immune status with protection against influenza and RSV infection in unvaccinated older adults, and to assess the exposure to avian influenza viruses in this population.
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Affiliation(s)
- Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, Li Ka Shing Faculty of Medicine, School of Public Health, University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Cuiling Xu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, Li Ka Shing Faculty of Medicine, School of Public Health, University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
- Chinese National Influenza Center, National Institute for Viral Disease Control and Prevention, Collaboration Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
- Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, China
| | - Fenyang Tang
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China
| | - Jun Zhang
- Suzhou Center for Disease Prevention and Control, Suzhou, China
| | - Jinjin Shen
- Yancheng Center for Disease Prevention and Control, Yancheng, China
| | - Fiona Havers
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Nancy Hl Leung
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, Li Ka Shing Faculty of Medicine, School of Public Health, University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Carolyn Greene
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Ying Song
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ran Zhang
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lindsay Kim
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yuyun Chen
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, Li Ka Shing Faculty of Medicine, School of Public Health, University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Daniel Kw Chu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, Li Ka Shing Faculty of Medicine, School of Public Health, University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Huachen Zhu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, Li Ka Shing Faculty of Medicine, School of Public Health, University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Yuelong Shu
- Chinese National Influenza Center, National Institute for Viral Disease Control and Prevention, Collaboration Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
- Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, China
| | - Hongjie Yu
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Mark G Thompson
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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The high frequency of non-aspartic acid residues at HA222 in influenza A(H1N1) 2009 pandemic viruses is associated with mortality during the upsurge of 2015: a molecular and epidemiological study from central India. Epidemiol Infect 2017; 145:2656-2665. [DOI: 10.1017/s0950268817001595] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
SUMMARYInfluenza A(H1N1) viruses of the 2009 pandemic (A(H1N1)pdm09) continue to cause outbreaks in the post-pandemic period. During January to May 2015, an upsurge of influenza was recorded that resulted in high fatality in central India. Genetic lineage, mutations in the hemagglutinin (HA) gene and infection by quasi-species are reported to affect disease severity. The objective of this study is to present the molecular and epidemiological trends during the 2015 influenza outbreak in central India. All the referred samples were subjected to qRT–PCR for diagnosis. HA gene sequencing (23 survivors and 24 non-survivors) and cloning were performed and analyzed using Molecular Evolutionary Genomic Analyzer (MEGA 5·05). Of the 3625 tested samples, 1607 (44·3%) were positive for influenza A(H1N1)pdm09, of which 228 (14·2%) individuals succumbed to death. A significant trend was observed in positivity (P = 0·003) and mortality (P < 0·0001) with increasing age. The circulating A(H1N1)pdm09 virus was characterized as belonging to clade-6B. Clinically significant mutations were detected. Patients infected with the quasi-species of the virus had a greater risk of death (P = 0·009). This study proposes a robust molecular and clinical surveillance program for the detection and characterization of the virus, along with prompt treatment protocols to prevent outbreaks.
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Sundaram N, Schaetti C, Purohit V, Kudale A, Weiss MG. Cultural epidemiology of pandemic influenza in urban and rural Pune, India: a cross-sectional, mixed-methods study. BMJ Open 2014; 4:e006350. [PMID: 25492273 PMCID: PMC4265096 DOI: 10.1136/bmjopen-2014-006350] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To identify and compare sociocultural features of pandemic influenza with reference to illness-related experience, meaning and behaviour in urban and rural areas of India. DESIGN Cross-sectional, mixed-methods, cultural epidemiological survey with vignette-based interviews. Semistructured explanatory model interviews were used to study community ideas of the 2009 influenza pandemic. In-depth interviews elaborated respondents' experience during the pandemic. SETTING Urban and rural communities, Pune district, western India. PARTICIPANTS Survey of urban (n=215) and rural (n=221) residents aged between 18 and 65 years. In-depth interviews of respondents with a history of 2009 pandemic influenza (n=6). RESULTS More urban (36.7%) than rural respondents (16.3%, p<0.001) identified the illness in the vignette as 'swine flu'. Over half (56.7%) believed the illness would be fatal without treatment, but with treatment 96% predicted full recovery. Worry ('tension') about the illness was reported as more troubling than somatic symptoms. The most common perceived causes-'exposure to a dirty environment' and 'cough or sneeze of an infected person'-were more prominent in the urban group. Among rural respondents, climatic conditions, drinking contaminated water, tension and cultural ideas on humoral imbalance from heat-producing or cold-producing foods were more prominent. The most widely reported home treatment was herbal remedies; more rural respondents suggested reliance on prayer, and symptom relief was more of a priority for urban respondents. Government health services were preferred in the urban communities, and rural residents relied more than urban residents on private facilities. The important preventive measures emphasised were cleanliness, wholesome lifestyle and vaccines, and more urban respondents reported the use of masks. In-depth interviews indicated treatment delays during the 2009 pandemic, especially among rural patients. CONCLUSIONS Although the term was well known, better recognition of pandemic influenza cases is needed, especially in rural areas. Improved awareness, access to treatment and timely referrals by private practitioners are also required to reduce treatment delays.
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Affiliation(s)
- Neisha Sundaram
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Christian Schaetti
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Vidula Purohit
- Centre for Health Research and Development, The Maharashtra Association of Anthropological Sciences, Pune, Maharashtra, India
| | - Abhay Kudale
- Centre for Health Research and Development, The Maharashtra Association of Anthropological Sciences, Pune, Maharashtra, India
| | - Mitchell G Weiss
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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