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Rachmat A, Kelly GC, Tran LK, Christy N, Supaprom C, Heang V, Dul S, Garcia-Rivera JA, Prom S, Sopheab H, Brooks JS, Sutherland IJ, Corson KS, Letizia AG. Clinical Presentation, Risk Factors, and Comparison of Laboratory Diagnostics for Seasonal Influenza Virus Among Cambodians From 2007 to 2020. Open Forum Infect Dis 2024; 11:ofae062. [PMID: 38524221 PMCID: PMC10960604 DOI: 10.1093/ofid/ofae062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/20/2024] [Indexed: 03/26/2024] Open
Abstract
Background Despite its global significance, challenges associated with understanding the epidemiology and accurately detecting, measuring, and characterizing the true burden of seasonal influenza remain in many resource-poor settings. Methods A prospective observational study was conducted in Cambodia at 28 health facilities between 2007 and 2020 utilizing passive surveillance data of patients presenting with acute undifferentiated febrile illness (AUFI) to describe the prevalence of influenza A and B and characterize associated risk factors and symptoms using a questionnaire. A comparison of rapid influenza diagnostic tests (RIDTs) and real-time reverse transcription polymerase chain reaction (rRT-PCR) results was also conducted. Results Of 30 586 total participants, 5634 (18.4%) tested positive for either influenza A or B, with 3557 (11.6%) positive for influenza A and 2288 (7.5%) positive for influenza B during the study. Influenza A and B were strongly associated with the rainy season (odds ratio [OR], 2.30; P < .001) and being from an urban area (OR, 1.45; P < .001). Analysis of individual symptoms identified cough (OR, 2.8; P < .001), chills (OR, 1.4; P < .001), and sore throat (OR, 1.4; P < .001) as having the strongest positive associations with influenza among patients with AUFI. Analysis comparing RIDTs and rRT-PCR calculated the overall sensitivity of rapid tests to be 0.492 (95% CI, 0.479-0.505) and specificity to be 0.993 (95% CI, 0.992-0.994) for both influenza type A and B. Conclusions Findings from this 14-year study include describing the epidemiology of seasonal influenza over a prolonged time period and identifying key risk factors and clinical symptoms associated with infection; we also demonstrate the poor sensitivity of RIDTs in Cambodia.
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Affiliation(s)
- Agus Rachmat
- AC Investment Co, contractor for NAMRU INDO PACIFIC, Phnom Penh, Cambodia
| | | | | | | | - Chonthida Supaprom
- AC Investment Co, contractor for NAMRU INDO PACIFIC, Phnom Penh, Cambodia
| | - Vireak Heang
- AC Investment Co, contractor for NAMRU INDO PACIFIC, Phnom Penh, Cambodia
| | - Sokha Dul
- AC Investment Co, contractor for NAMRU INDO PACIFIC, Phnom Penh, Cambodia
| | | | - Satharath Prom
- Department of Health, Ministry of National Defense, Phnom Penh, Cambodia
| | - Heng Sopheab
- National Institute of Public Health, Ministry of Health, Phnom Penh, Cambodia
| | - John S Brooks
- US Naval Medical Research Unit INDO PACIFIC, Cambodia
| | | | - Karen S Corson
- US Naval Medical Research Unit INDO PACIFIC, Singapore
- US Naval Medical Research Unit INDO PACIFIC, Cambodia
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Boukli N, Flamand C, Chea KL, Heng L, Keo S, Sour K, In S, Chhim P, Chhor B, Kruy L, Feenstra JDM, Gandhi M, Okafor O, Ulekleiv C, Auerswald H, Horm VS, Karlsson EA. One assay to test them all: Multiplex assays for expansion of respiratory virus surveillance. Front Med (Lausanne) 2023; 10:1161268. [PMID: 37168265 PMCID: PMC10165998 DOI: 10.3389/fmed.2023.1161268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/24/2023] [Indexed: 05/13/2023] Open
Abstract
Molecular multiplex assays (MPAs) for simultaneous detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza and respiratory syncytial virus (RSV) in a single RT-PCR reaction reduce time and increase efficiency to identify multiple pathogens with overlapping clinical presentation but different treatments or public health implications. Clinical performance of XpertXpress® SARS-CoV-2/Flu/RSV (Cepheid, GX), TaqPath™ COVID-19, FluA/B, RSV Combo kit (Thermo Fisher Scientific, TP), and PowerChek™ SARS-CoV-2/Influenza A&B/RSV Multiplex RT-PCR kit II (KogeneBiotech, PC) was compared to individual Standards of Care (SoC). Thirteen isolates of SARS-CoV-2, human seasonal influenza, and avian influenza served to assess limit of detection (LoD). Then, positive and negative residual nasopharyngeal specimens, collected under public health surveillance and pandemic response served for evaluation. Subsequently, comparison of effectiveness was assessed. The three MPAs confidently detect all lineages of SARS-CoV-2 and influenza viruses. MPA-LoDs vary from 1 to 2 Log10 differences from SoC depending on assay and strain. Clinical evaluation resulted in overall agreement between 97 and 100%, demonstrating a high accuracy to detect all targets. Existing differences in costs, testing burden and implementation constraints influence the choice in primary or community settings. TP, PC and GX, reliably detect SARS-CoV-2, influenza and RSV simultaneously, with reduced time-to-results and simplified workflows. MPAs have the potential to enhance diagnostics, surveillance system, and epidemic response to drive policy on prevention and control of viral respiratory infections.
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Affiliation(s)
- Narjis Boukli
- Virology Unit, National Influenza Center, WHO H5 Regional Reference Laboratory, World Health Organization COVID-19 Global Referral Laboratory, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Claude Flamand
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, CNRS, Paris, France
| | - Kim Lay Chea
- Virology Unit, National Influenza Center, WHO H5 Regional Reference Laboratory, World Health Organization COVID-19 Global Referral Laboratory, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Leangyi Heng
- Virology Unit, National Influenza Center, WHO H5 Regional Reference Laboratory, World Health Organization COVID-19 Global Referral Laboratory, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Seangmai Keo
- Virology Unit, National Influenza Center, WHO H5 Regional Reference Laboratory, World Health Organization COVID-19 Global Referral Laboratory, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Kimhoung Sour
- Virology Unit, National Influenza Center, WHO H5 Regional Reference Laboratory, World Health Organization COVID-19 Global Referral Laboratory, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Sophea In
- Virology Unit, National Influenza Center, WHO H5 Regional Reference Laboratory, World Health Organization COVID-19 Global Referral Laboratory, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Panha Chhim
- Virology Unit, National Influenza Center, WHO H5 Regional Reference Laboratory, World Health Organization COVID-19 Global Referral Laboratory, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Bunthea Chhor
- Virology Unit, National Influenza Center, WHO H5 Regional Reference Laboratory, World Health Organization COVID-19 Global Referral Laboratory, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Lomor Kruy
- Virology Unit, National Influenza Center, WHO H5 Regional Reference Laboratory, World Health Organization COVID-19 Global Referral Laboratory, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | | | - Manoj Gandhi
- Thermo Fisher Scientific, South San Francisco CA, United States
| | - Obiageli Okafor
- Thermo Fisher Scientific, South San Francisco CA, United States
| | | | - Heidi Auerswald
- Virology Unit, National Influenza Center, WHO H5 Regional Reference Laboratory, World Health Organization COVID-19 Global Referral Laboratory, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Viseth Srey Horm
- Virology Unit, National Influenza Center, WHO H5 Regional Reference Laboratory, World Health Organization COVID-19 Global Referral Laboratory, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Erik A. Karlsson
- Virology Unit, National Influenza Center, WHO H5 Regional Reference Laboratory, World Health Organization COVID-19 Global Referral Laboratory, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
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Genetic and Antigenic Characterization of an Influenza A(H3N2) Outbreak in Cambodia and the Greater Mekong Subregion during the COVID-19 Pandemic, 2020. J Virol 2021; 95:e0126721. [PMID: 34586866 PMCID: PMC8610588 DOI: 10.1128/jvi.01267-21] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction of non-pharmaceutical interventions to control COVID-19 in early 2020 coincided with a global decrease in active influenza circulation. However, between July and November 2020, an influenza A(H3N2) epidemic occurred in Cambodia and in other neighboring countries in the Greater Mekong Subregion in Southeast Asia. We characterized the genetic and antigenic evolution of A(H3N2) in Cambodia and found that the 2020 epidemic comprised genetically and antigenically similar viruses of Clade3C2a1b/131K/94N, but they were distinct from the WHO recommended influenza A(H3N2) vaccine virus components for 2020–2021 Northern Hemisphere season. Phylogenetic analysis revealed multiple virus migration events between Cambodia and bordering countries, with Laos PDR and Vietnam also reporting similar A(H3N2) epidemics immediately following the Cambodia outbreak: however, there was limited circulation of these viruses elsewhere globally. In February 2021, a virus from the Cambodian outbreak was recommended by WHO as the prototype virus for inclusion in the 2021–2022 Northern Hemisphere influenza vaccine. IMPORTANCE The 2019 coronavirus disease (COVID-19) pandemic has significantly altered the circulation patterns of respiratory diseases worldwide and disrupted continued surveillance in many countries. Introduction of control measures in early 2020 against Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection has resulted in a remarkable reduction in the circulation of many respiratory diseases. Influenza activity has remained at historically low levels globally since March 2020, even when increased influenza testing was performed in some countries. Maintenance of the influenza surveillance system in Cambodia in 2020 allowed for the detection and response to an influenza A(H3N2) outbreak in late 2020, resulting in the inclusion of this virus in the 2021–2022 Northern Hemisphere influenza vaccine.
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Duong BT, Bal J, Sung HW, Yeo SJ, Park H. Molecular Analysis of the Avian H7 Influenza Viruses Circulating in South Korea during 2018-2019: Evolutionary Significance and Associated Zoonotic Threats. Viruses 2021; 13:v13112260. [PMID: 34835066 PMCID: PMC8623559 DOI: 10.3390/v13112260] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/04/2021] [Accepted: 11/08/2021] [Indexed: 12/18/2022] Open
Abstract
Avian influenza virus (AIV) subtypes H5 and H7, possessing the ability to mutate spontaneously from low pathogenic (LP) to highly pathogenic (HP) variants, are major concerns for enormous socio-economic losses in the poultry industry, as well as for fatal human infections. Through antigenic drift and shift, genetic reassortments of the genotypes pose serious threats of increased virulence and pathogenicity leading to potential pandemics. In this study, we isolated the H7-subtype AIVs circulating in the Republic of Korea during 2018–2019, and perform detailed molecular analysis to study their circulation, evolution, and possible emergence as a zoonotic threat. Phylogenetic and nucleotide sequence analyses of these isolates revealed their distribution into two distinct clusters, with the HA gene sharing the highest nucleotide identity with either the A/common teal/Shanghai/CM1216/2017, isolated from wild birds in Shanghai, China, or the A/duck/Shimane/2014, isolated from Japan. Mutations were found in HA (S138A (H3 numbering)), M1 (N30D and T215A), NS1 (P42S), PB2 (L89V), and PA (H266R and F277S) proteins—the mutations had previously been reported to be related to mammalian adaptation and changes in the virulence of AIVs. Taken together, the results firmly put forth the demand for routine surveillance of AIVs in wild birds to prevent possible pandemics arising from reassortant AIVs.
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Affiliation(s)
- Bao Tuan Duong
- Zoonosis Research Center, Department of Infection Biology, School of Medicine, Wonkwang University, Iksan 54538, Korea; (B.T.D.); (J.B.)
| | - Jyotiranjan Bal
- Zoonosis Research Center, Department of Infection Biology, School of Medicine, Wonkwang University, Iksan 54538, Korea; (B.T.D.); (J.B.)
| | - Haan Woo Sung
- College of Veterinary Medicine, Kangwon National University, Chuncheon-si 24341, Korea
- Correspondence: (H.W.S.); (S.-J.Y.); (H.P.)
| | - Seon-Ju Yeo
- Department of Tropical Medicine and Parasitology, Seoul National University College of Medicine, Seoul 03080, Korea
- Correspondence: (H.W.S.); (S.-J.Y.); (H.P.)
| | - Hyun Park
- Zoonosis Research Center, Department of Infection Biology, School of Medicine, Wonkwang University, Iksan 54538, Korea; (B.T.D.); (J.B.)
- Correspondence: (H.W.S.); (S.-J.Y.); (H.P.)
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An influenza A (H3N2) virus outbreak in the Kingdom of Cambodia during the COVID-19 pandemic of 2020. Int J Infect Dis 2021; 103:352-357. [DOI: 10.1016/j.ijid.2020.11.178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/17/2020] [Accepted: 11/20/2020] [Indexed: 11/17/2022] Open
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Boff L, Schreiber A, da Rocha Matos A, Del Sarto J, Brunotte L, Munkert J, Melo Ottoni F, Silva Ramos G, Kreis W, Castro Braga F, José Alves R, Maia de Pádua R, Maria Oliveira Simões C, Ludwig S. Semisynthetic Cardenolides Acting as Antiviral Inhibitors of Influenza A Virus Replication by Preventing Polymerase Complex Formation. Molecules 2020; 25:molecules25204853. [PMID: 33096707 PMCID: PMC7587960 DOI: 10.3390/molecules25204853] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 02/05/2023] Open
Abstract
Influenza virus infections represent a major public health issue by causing annual epidemics and occasional pandemics that affect thousands of people worldwide. Vaccination is the main prophylaxis to prevent these epidemics/pandemics, although the effectiveness of licensed vaccines is rather limited due to the constant mutations of influenza virus antigenic characteristics. The available anti-influenza drugs are still restricted and there is an increasing viral resistance to these compounds, thus highlighting the need for research and development of new antiviral drugs. In this work, two semisynthetic derivatives of digitoxigenin, namely C10 (3β-((N-(2-hydroxyethyl)aminoacetyl)amino-3-deoxydigitoxigenin) and C11 (3β-(hydroxyacetyl)amino-3-deoxydigitoxigenin), showed anti-influenza A virus activity by affecting the expression of viral proteins at the early and late stages of replication cycle, and altering the transcription and synthesis of new viral proteins, thereby inhibiting the formation of new virions. Such antiviral action occurred due to the interference in the assembly of viral polymerase, resulting in an impaired polymerase activity and, therefore, reducing viral replication. Confirming the in vitro results, a clinically relevant ex vivo model of influenza virus infection of human tumor-free lung tissues corroborated the potential of these compounds, especially C10, to completely abrogate influenza A virus replication at the highest concentration tested (2.0 µM). Taken together, these promising results demonstrated that C10 and C11 can be considered as potential new anti-influenza drug candidates.
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Affiliation(s)
- Laurita Boff
- Institute of Virology (IVM), Centre for Molecular Biology of Inflammation (ZMBE), Westfaelische Wilhelms University (WWU), 48149 Münster, Germany; (L.B.); (A.S.); (A.d.R.M.); (J.D.S.); (L.B.); (S.L.)
- Laboratory of Applied Virology, Department of Pharmaceutical Sciences, Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina 88040-900, Brazil
| | - André Schreiber
- Institute of Virology (IVM), Centre for Molecular Biology of Inflammation (ZMBE), Westfaelische Wilhelms University (WWU), 48149 Münster, Germany; (L.B.); (A.S.); (A.d.R.M.); (J.D.S.); (L.B.); (S.L.)
| | - Aline da Rocha Matos
- Institute of Virology (IVM), Centre for Molecular Biology of Inflammation (ZMBE), Westfaelische Wilhelms University (WWU), 48149 Münster, Germany; (L.B.); (A.S.); (A.d.R.M.); (J.D.S.); (L.B.); (S.L.)
- Respiratory Viruses and Measles Laboratory, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro 22775-051, Brazil
| | - Juliana Del Sarto
- Institute of Virology (IVM), Centre for Molecular Biology of Inflammation (ZMBE), Westfaelische Wilhelms University (WWU), 48149 Münster, Germany; (L.B.); (A.S.); (A.d.R.M.); (J.D.S.); (L.B.); (S.L.)
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil; (F.M.O.); (G.S.R.); (F.C.B.); (R.J.A.); (R.M.d.P.)
| | - Linda Brunotte
- Institute of Virology (IVM), Centre for Molecular Biology of Inflammation (ZMBE), Westfaelische Wilhelms University (WWU), 48149 Münster, Germany; (L.B.); (A.S.); (A.d.R.M.); (J.D.S.); (L.B.); (S.L.)
| | - Jennifer Munkert
- Pharmaceutical Biology, Department of Biology, Friedrich-Alexander-University, 91054 Erlangen-Nuremberg, Germany; (J.M.); (W.K.)
| | - Flaviano Melo Ottoni
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil; (F.M.O.); (G.S.R.); (F.C.B.); (R.J.A.); (R.M.d.P.)
| | - Gabriela Silva Ramos
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil; (F.M.O.); (G.S.R.); (F.C.B.); (R.J.A.); (R.M.d.P.)
| | - Wolfgang Kreis
- Pharmaceutical Biology, Department of Biology, Friedrich-Alexander-University, 91054 Erlangen-Nuremberg, Germany; (J.M.); (W.K.)
| | - Fernão Castro Braga
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil; (F.M.O.); (G.S.R.); (F.C.B.); (R.J.A.); (R.M.d.P.)
| | - Ricardo José Alves
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil; (F.M.O.); (G.S.R.); (F.C.B.); (R.J.A.); (R.M.d.P.)
| | - Rodrigo Maia de Pádua
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil; (F.M.O.); (G.S.R.); (F.C.B.); (R.J.A.); (R.M.d.P.)
| | - Cláudia Maria Oliveira Simões
- Laboratory of Applied Virology, Department of Pharmaceutical Sciences, Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina 88040-900, Brazil
- Correspondence:
| | - Stephan Ludwig
- Institute of Virology (IVM), Centre for Molecular Biology of Inflammation (ZMBE), Westfaelische Wilhelms University (WWU), 48149 Münster, Germany; (L.B.); (A.S.); (A.d.R.M.); (J.D.S.); (L.B.); (S.L.)
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Suntronwong N, Vichaiwattana P, Klinfueng S, Korkong S, Thongmee T, Vongpunsawad S, Poovorawan Y. Climate factors influence seasonal influenza activity in Bangkok, Thailand. PLoS One 2020; 15:e0239729. [PMID: 32991630 PMCID: PMC7523966 DOI: 10.1371/journal.pone.0239729] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 09/12/2020] [Indexed: 12/05/2022] Open
Abstract
Yearly increase in influenza activity is associated with cold and dry winter in the temperate regions, while influenza patterns in tropical countries vary significantly by regional climates and geographic locations. To examine the association between influenza activity in Thailand and local climate factors including temperature, relative humidity, and rainfall, we analyzed the influenza surveillance data from January 2010 to December 2018 obtained from a large private hospital in Bangkok. We found that approximately one in five influenza-like illness samples (21.6% or 6,678/30,852) tested positive for influenza virus. Influenza virus typing showed that 34.2% were influenza A(H1N1)pdm09, 46.0% were influenza A(H3N2), and 19.8% were influenza B virus. There were two seasonal waves of increased influenza activity. Peak influenza A(H1N1)pdm09 activity occurred in February and again in August, while influenza A(H3N2) and influenza B viruses were primarily detected in August and September. Time series analysis suggests that increased relative humidity was significantly associated with increased influenza activity in Bangkok. Months with peak influenza activity generally followed the most humid months of the year. We performed the seasonal autoregressive integrated moving average (SARIMA) multivariate analysis of all influenza activity on the 2011 to 2017 data to predict the influenza activity for 2018. The resulting model closely resembled the actual observed overall influenza detected that year. Consequently, the ability to predict seasonal pattern of influenza in a large tropical city such as Bangkok may enable better public health planning and underscores the importance of annual influenza vaccination prior to the rainy season.
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Affiliation(s)
- Nungruthai Suntronwong
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Preeyaporn Vichaiwattana
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sirapa Klinfueng
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sumeth Korkong
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thanunrat Thongmee
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sompong Vongpunsawad
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Yong Poovorawan
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Korsun N, Daniels R, Angelova S, Ermetal B, Grigorova I, Voleva S, Trifonova I, Kurchatova A, McCauley J. Genetic diversity of influenza A viruses circulating in Bulgaria during the 2018-2019 winter season. J Med Microbiol 2020; 69:986-998. [PMID: 32459617 PMCID: PMC7481746 DOI: 10.1099/jmm.0.001198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Introduction Influenza viruses evolve rapidly and change their antigenic characteristics, necessitating biannual updates of flu vaccines. Aim The aim of this study was to characterize influenza viruses circulating in Bulgaria during the 2018/2019 season and to identify amino acid substitutions in them that might impact vaccine effectiveness. Methodology Typing/subtyping of influenza viruses were performed using real-time Reverse Transcription-PCR (RT-PCR) and results of phylogenetic and amino acid sequence analyses of influenza strains are presented. Results A(H1N1)pdm09 (66 %) predominated over A(H3N2) (34 %) viruses, with undetected circulation of B viruses in the 2018/2019 season. All A(H1N1)pdm09 viruses studied fell into the recently designated 6B.1A subclade with over 50 % falling in four subgroups: 6B.1A2, 6B.1A5, 6B.1A6 and 6B.1A7. Analysed A(H3N2) viruses belonged to subclades 3C.2a1b and 3C.2a2. Amino acid sequence analysis of 36 A(H1N1)pdm09 isolates revealed the presence of six–ten substitutions in haemagglutinin (HA), compared to the A/Michigan/45/2015 vaccine virus, three of which occurred in antigenic sites Sa and Cb, together with four–nine changes at positions in neuraminidase (NA), and a number of substitutions in internal proteins. HA1 D222N substitution, associated with increased virulence, was identified in two A(H1N1)pdm09 viruses. Despite the presence of several amino acid substitutions, A(H1N1)pdm09 viruses remained antigenically similar to the vaccine virus. The 28 A(H3N2) viruses characterized carried substitutions in HA, including some in antigenic sites A, B, C and E, in NA and internal protein sequences. Conclusion The results of this study showed the genetic diversity of circulating influenza viruses and the need for continuous antigenic and molecular surveillance.
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Affiliation(s)
- Neli Korsun
- National Laboratory "Influenza and ARI", Department of Virology, National Centre of Infectious and Parasitic Diseases, 44A Stoletov Blvd, 1233 Sofia, Bulgaria
| | - Rodney Daniels
- WHO Collaborating Centre for Reference and Research on Influenza, Worldwide Influenza Centre, The Francis Crick Institute, 1 Midland Road, London NW1 1AT, UK
| | - Svetla Angelova
- National Laboratory "Influenza and ARI", Department of Virology, National Centre of Infectious and Parasitic Diseases, 44A Stoletov Blvd, 1233 Sofia, Bulgaria
| | - Burcu Ermetal
- WHO Collaborating Centre for Reference and Research on Influenza, Worldwide Influenza Centre, The Francis Crick Institute, 1 Midland Road, London NW1 1AT, UK
| | - Iliyana Grigorova
- National Laboratory "Influenza and ARI", Department of Virology, National Centre of Infectious and Parasitic Diseases, 44A Stoletov Blvd, 1233 Sofia, Bulgaria
| | - Silvia Voleva
- National Laboratory "Influenza and ARI", Department of Virology, National Centre of Infectious and Parasitic Diseases, 44A Stoletov Blvd, 1233 Sofia, Bulgaria
| | - Ivelina Trifonova
- National Laboratory "Influenza and ARI", Department of Virology, National Centre of Infectious and Parasitic Diseases, 44A Stoletov Blvd, 1233 Sofia, Bulgaria
| | - Anna Kurchatova
- Department of Epidemiology, National Centre of Infectious and Parasitic Diseases, 26 Yanko Sakazov Blvd, 1504 Sofia, Bulgaria
| | - John McCauley
- WHO Collaborating Centre for Reference and Research on Influenza, Worldwide Influenza Centre, The Francis Crick Institute, 1 Midland Road, London NW1 1AT, UK
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Zhu A, Liu J, Ye C, Yu J, Peng Z, Feng L, Wang L, Qin Y, Zheng Y, Li Z. Characteristics of Seasonal Influenza Virus Activity in a Subtropical City in China, 2013-2019. Vaccines (Basel) 2020; 8:vaccines8010108. [PMID: 32121519 PMCID: PMC7157579 DOI: 10.3390/vaccines8010108] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 02/27/2020] [Accepted: 02/27/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND To optimize seasonal influenza vaccination programs in regions with potentially complicated seasonal patterns, the epidemiological characteristics of seasonal influenza activity in a subtropical city of China were explored. MATERIALS AND METHODS Influenza virus data of patients with influenza-like illness (ILI) during 2013-2019 were collected from two sentinel hospitals in a subtropical region of China, Yichang city. The influenza virus positive rate among sampled ILI cases served as a proxy to estimate influenza seasonal characteristics, including periodicity, duration, peaks, and predominant subtypes/lineages. Epidemiological features of different years, seasons and age groups were analyzed, and vaccine mismatches were identified. RESULTS In total, 8693 ILI cases were included; 1439 (16.6%) were laboratory-confirmed influenza cases. The influenza A positive rate (10.6%) was higher than the influenza B positive rate (5.9%). There were three influenza circulation patterns in Yichang: (1) annual periodicity (in 2013-2014, 2015-2016 and 2018-2019), (2) semiannual periodicity (in 2014-2015), and (3) year-round periodicity (in 2016-2017 and 2017-2018). Summer epidemics existed in two of the six years and were dominated by influenza A/H3N2. Winter and spring epidemics occurred in five of the six years, and A/H1N1, A/H3N2, B/Victoria, and B/Yamagata were codominant. During the study period, the predominant lineages, B/Victoria in 2015-16 and B/Yamagata in 2017-2018, were both mismatched with the influenza B component of the trivalent vaccine. Children 5-14 years old (26.4%) and individuals over 60 years old (16.9%) had the highest influenza positive rates. CONCLUSIONS The seasonal epidemic period and the predominant subtype/lineage of influenza viruses in Yichang city are complex. Influenza vaccination timing and strategies need to be optimized according to the local features of influenza virus activity.
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Affiliation(s)
- Aiqin Zhu
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China; (A.Z.); (J.Y.); (Z.P.); (L.F.); (L.W.); (Y.Q.); (Y.Z.)
| | - Jianhua Liu
- Yichang Center for Disease Control and Prevention, Yichang 443003, China;
| | - Chuchu Ye
- Research Base of Key Laboratory of Surveillance and Early Warning of Infectious Disease, Pudong New Area Center for Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Shanghai 200136, China;
| | - Jianxing Yu
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China; (A.Z.); (J.Y.); (Z.P.); (L.F.); (L.W.); (Y.Q.); (Y.Z.)
| | - Zhibing Peng
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China; (A.Z.); (J.Y.); (Z.P.); (L.F.); (L.W.); (Y.Q.); (Y.Z.)
| | - Luzhao Feng
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China; (A.Z.); (J.Y.); (Z.P.); (L.F.); (L.W.); (Y.Q.); (Y.Z.)
| | - Liping Wang
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China; (A.Z.); (J.Y.); (Z.P.); (L.F.); (L.W.); (Y.Q.); (Y.Z.)
| | - Ying Qin
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China; (A.Z.); (J.Y.); (Z.P.); (L.F.); (L.W.); (Y.Q.); (Y.Z.)
| | - Yaming Zheng
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China; (A.Z.); (J.Y.); (Z.P.); (L.F.); (L.W.); (Y.Q.); (Y.Z.)
| | - Zhongjie Li
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China; (A.Z.); (J.Y.); (Z.P.); (L.F.); (L.W.); (Y.Q.); (Y.Z.)
- Correspondence: ; Tel.: +86-010-5890-0543
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10
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Quantifying within-host diversity of H5N1 influenza viruses in humans and poultry in Cambodia. PLoS Pathog 2020; 16:e1008191. [PMID: 31951644 PMCID: PMC6992230 DOI: 10.1371/journal.ppat.1008191] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 01/30/2020] [Accepted: 11/04/2019] [Indexed: 12/31/2022] Open
Abstract
Avian influenza viruses (AIVs) periodically cross species barriers and infect humans. The likelihood that an AIV will evolve mammalian transmissibility depends on acquiring and selecting mutations during spillover, but data from natural infection is limited. We analyze deep sequencing data from infected humans and domestic ducks in Cambodia to examine how H5N1 viruses evolve during spillover. Overall, viral populations in both species are predominated by low-frequency (<10%) variation shaped by purifying selection and genetic drift, and half of the variants detected within-host are never detected on the H5N1 virus phylogeny. However, we do detect a subset of mutations linked to human receptor binding and replication (PB2 E627K, HA A150V, and HA Q238L) that arose in multiple, independent humans. PB2 E627K and HA A150V were also enriched along phylogenetic branches leading to human infections, suggesting that they are likely human-adaptive. Our data show that H5N1 viruses generate putative human-adapting mutations during natural spillover infection, many of which are detected at >5% frequency within-host. However, short infection times, genetic drift, and purifying selection likely restrict their ability to evolve extensively during a single infection. Applying evolutionary methods to sequence data, we reveal a detailed view of H5N1 virus adaptive potential, and develop a foundation for studying host-adaptation in other zoonotic viruses. H5N1 avian influenza viruses can cross species barriers and cause severe disease in humans. H5N1 viruses currently cannot replicate and transmit efficiently among humans, but animal infection studies and modeling experiments have suggested that human adaptation may require only a few mutations. However, data from natural spillover infection has been limited, posing a challenge for risk assessment. Here, we analyze a unique dataset of deep sequence data from H5N1 virus-infected humans and domestic ducks in Cambodia. We find that well-known markers of human receptor binding and replication arise in multiple, independent humans. We also find that 3 mutations detected within-host are enriched along phylogenetic branches leading to human infections, suggesting that they are likely human-adapting. However, we also show that within-host evolution in both humans and ducks are shaped heavily by purifying selection and genetic drift, and that a large fraction of within-host variation is never detected on the H5N1 phylogeny. Taken together, our data show that H5N1 viruses do generate human-adapting mutations during natural infection. However, short infection times, purifying selection, and genetic drift may severely limit how much H5N1 viruses can evolve during the course of a single infection.
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11
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Diversity of A(H5N1) clade 2.3.2.1c avian influenza viruses with evidence of reassortment in Cambodia, 2014-2016. PLoS One 2019; 14:e0226108. [PMID: 31815962 PMCID: PMC6901219 DOI: 10.1371/journal.pone.0226108] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 11/18/2019] [Indexed: 11/19/2022] Open
Abstract
In Cambodia, highly pathogenic avian influenza A(H5N1) subtype viruses circulate endemically causing poultry outbreaks and zoonotic human cases. To investigate the genomic diversity and development of endemicity of the predominantly circulating clade 2.3.2.1c A(H5N1) viruses, we characterised 68 AIVs detected in poultry, the environment and from a single human A(H5N1) case from January 2014 to December 2016. Full genomes were generated for 42 A(H5N1) viruses. Phylogenetic analysis shows that five clade 2.3.2.1c genotypes, designated KH1 to KH5, were circulating in Cambodia during this period. The genotypes arose through multiple reassortment events with the neuraminidase (NA) and internal genes belonging to H5N1 clade 2.3.2.1a, clade 2.3.2.1b or A(H9N2) lineages. Phylogenies suggest that the Cambodian AIVs were derived from viruses circulating between Cambodian and Vietnamese poultry. Molecular analyses show that these viruses contained the hemagglutinin (HA) gene substitutions D94N, S133A, S155N, T156A, T188I and K189R known to increase binding to the human-type α2,6-linked sialic acid receptors. Two A(H5N1) viruses displayed the M2 gene S31N or A30T substitutions indicative of adamantane resistance, however, susceptibility testing towards neuraminidase inhibitors (oseltamivir, zanamivir, lananmivir and peramivir) of a subset of thirty clade 2.3.2.1c viruses showed susceptibility to all four drugs. This study shows that A(H5N1) viruses continue to reassort with other A(H5N1) and A(H9N2) viruses that are endemic in the region, highlighting the risk of introduction and emergence of novel A(H5N1) genotypes in Cambodia.
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12
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Horwood PF, Karlsson EA, Horm SV, Ly S, Heng S, Chin S, Darapheak C, Saunders D, Chanthap L, Rith S, Y P, Chea KL, Sar B, Parry A, Ieng V, Tsuyouka R, Deng YM, Hurt AC, Barr IG, Komadina N, Buchy P, Dussart P. Circulation and characterization of seasonal influenza viruses in Cambodia, 2012-2015. Influenza Other Respir Viruses 2019; 13:465-476. [PMID: 31251478 PMCID: PMC6692578 DOI: 10.1111/irv.12647] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 12/13/2018] [Accepted: 04/26/2019] [Indexed: 12/04/2022] Open
Abstract
Background Influenza virus circulation is monitored through the Cambodian influenza‐like illness (ILI) sentinel surveillance system and isolates are characterized by the National Influenza Centre (NIC). Seasonal influenza circulation has previously been characterized by year‐round activity and a peak during the rainy season (June‐November). Objectives We documented the circulation of seasonal influenza in Cambodia for 2012‐2015 and investigated genetic, antigenic, and antiviral resistance characteristics of influenza isolates. Patients/Methods Respiratory samples were collected from patients presenting with influenza‐like illness (ILI) at 11 hospitals throughout Cambodia. First‐line screening was conducted by the National Institute of Public Health and the Armed Forces Research Institute of Medical Sciences. Confirmation of testing and genetic, antigenic and antiviral resistance characterization was conducted by Institute Pasteur in Cambodia, the NIC. Additional virus characterization was conducted by the WHO Collaborating Centre for Reference and Research on Influenza (Melbourne, Australia). Results Between 2012 and 2015, 1,238 influenza‐positive samples were submitted to the NIC. Influenza A(H3N2) (55.3%) was the dominant subtype, followed by influenza B (30.9%; predominantly B/Yamagata‐lineage) and A(H1N1)pdm09 (13.9%). Circulation of influenza viruses began earlier in 2014 and 2015 than previously described, coincident with the emergence of A(H3N2) clades 3C.2a and 3C.3a, respectively. There was high diversity in the antigenicity of A(H3N2) viruses, and to a smaller extent influenza B viruses, during this period, with some mismatches with the northern and southern hemisphere vaccine formulations. All isolates tested were susceptible to the influenza antiviral drugs oseltamivir and zanamivir. Conclusions Seasonal and year‐round co‐circulation of multiple influenza types/subtypes were detected in Cambodia during 2012‐2015.
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Affiliation(s)
- Paul F Horwood
- Virology Unit, Institute Pasteur in Cambodia, Institute Pasteur International Network, Phnom Penh, Cambodia.,Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
| | - Erik A Karlsson
- Virology Unit, Institute Pasteur in Cambodia, Institute Pasteur International Network, Phnom Penh, Cambodia
| | - Srey Viseth Horm
- Virology Unit, Institute Pasteur in Cambodia, Institute Pasteur International Network, Phnom Penh, Cambodia
| | - Sovann Ly
- Communicable Disease Control Department, Ministry of Health, Phnom Penh, Cambodia
| | - Seng Heng
- Communicable Disease Control Department, Ministry of Health, Phnom Penh, Cambodia
| | - Savuth Chin
- National Institute of Public Health, Phnom Penh, Cambodia
| | - Chau Darapheak
- National Institute of Public Health, Phnom Penh, Cambodia
| | - David Saunders
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Lon Chanthap
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Sareth Rith
- Virology Unit, Institute Pasteur in Cambodia, Institute Pasteur International Network, Phnom Penh, Cambodia
| | - Phalla Y
- Virology Unit, Institute Pasteur in Cambodia, Institute Pasteur International Network, Phnom Penh, Cambodia
| | - Kim Lay Chea
- Virology Unit, Institute Pasteur in Cambodia, Institute Pasteur International Network, Phnom Penh, Cambodia
| | - Borann Sar
- Centers for Disease Control and Prevention, Phnom Penh, Cambodia
| | - Amy Parry
- World Health Organization, Phnom Penh, Cambodia
| | - Vanra Ieng
- World Health Organization, Phnom Penh, Cambodia
| | | | - Yi-Mo Deng
- WHO Collaborating Centre for Reference and Research on Influenza, VIDRL, Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Aeron C Hurt
- WHO Collaborating Centre for Reference and Research on Influenza, VIDRL, Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Ian G Barr
- WHO Collaborating Centre for Reference and Research on Influenza, VIDRL, Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Naomi Komadina
- WHO Collaborating Centre for Reference and Research on Influenza, VIDRL, Peter Doherty Institute, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Philippe Buchy
- Virology Unit, Institute Pasteur in Cambodia, Institute Pasteur International Network, Phnom Penh, Cambodia.,GlaxoSmithKline Vaccines R&D Intercontinental, Singapore, Singapore
| | - Philippe Dussart
- Virology Unit, Institute Pasteur in Cambodia, Institute Pasteur International Network, Phnom Penh, Cambodia
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