1
|
Qualls N, Levitt A, Kanade N, Wright-Jegede N, Dopson S, Biggerstaff M, Reed C, Uzicanin A. Community Mitigation Guidelines to Prevent Pandemic Influenza - United States, 2017. MMWR Recomm Rep 2017. [PMID: 28426646 DOI: 10.15585/mmwr.rr6601a1externalicon] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/24/2023] Open
Abstract
When a novel influenza A virus with pandemic potential emerges, nonpharmaceutical interventions (NPIs) often are the most readily available interventions to help slow transmission of the virus in communities, which is especially important before a pandemic vaccine becomes widely available. NPIs, also known as community mitigation measures, are actions that persons and communities can take to help slow the spread of respiratory virus infections, including seasonal and pandemic influenza viruses.These guidelines replace the 2007 Interim Pre-pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States - Early, Targeted, Layered Use of Nonpharmaceutical Interventions (https://stacks.cdc.gov/view/cdc/11425). Several elements remain unchanged from the 2007 guidance, which described recommended NPIs and the supporting rationale and key concepts for the use of these interventions during influenza pandemics. NPIs can be phased in, or layered, on the basis of pandemic severity and local transmission patterns over time. Categories of NPIs include personal protective measures for everyday use (e.g., voluntary home isolation of ill persons, respiratory etiquette, and hand hygiene); personal protective measures reserved for influenza pandemics (e.g., voluntary home quarantine of exposed household members and use of face masks in community settings when ill); community measures aimed at increasing social distancing (e.g., school closures and dismissals, social distancing in workplaces, and postponing or cancelling mass gatherings); and environmental measures (e.g., routine cleaning of frequently touched surfaces).Several new elements have been incorporated into the 2017 guidelines. First, to support updated recommendations on the use of NPIs, the latest scientific evidence available since the influenza A (H1N1)pdm09 pandemic has been added. Second, a summary of lessons learned from the 2009 H1N1 pandemic response is presented to underscore the importance of broad and flexible prepandemic planning. Third, a new section on community engagement has been included to highlight that the timely and effective use of NPIs depends on community acceptance and active participation. Fourth, to provide new or updated pandemic assessment and planning tools, the novel influenza virus pandemic intervals tool, the Influenza Risk Assessment Tool, the Pandemic Severity Assessment Framework, and a set of prepandemic planning scenarios are described. Finally, to facilitate implementation of the updated guidelines and to assist states and localities with prepandemic planning and decision-making, this report links to six supplemental prepandemic NPI planning guides for different community settings that are available online (https://www.cdc.gov/nonpharmaceutical-interventions).
Collapse
Affiliation(s)
- Noreen Qualls
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
| | | | - Neha Kanade
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
- Eagle Medical Services, San Antonio, Texas
| | - Narue Wright-Jegede
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
- Karna, Atlanta, Georgia
| | - Stephanie Dopson
- Division of State and Local Readiness, Office of Public Health Preparedness and Response, CDC, Atlanta, Georgia
| | - Matthew Biggerstaff
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
| | - Carrie Reed
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
| | - Amra Uzicanin
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
| |
Collapse
|
2
|
Qualls N, Levitt A, Kanade N, Wright-Jegede N, Dopson S, Biggerstaff M, Reed C, Uzicanin A. Community Mitigation Guidelines to Prevent Pandemic Influenza - United States, 2017. MMWR Recomm Rep 2017; 66:1-34. [PMID: 28426646 PMCID: PMC5837128 DOI: 10.15585/mmwr.rr6601a1] [Citation(s) in RCA: 238] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
When a novel influenza A virus with pandemic potential emerges, nonpharmaceutical interventions (NPIs) often are the most readily available interventions to help slow transmission of the virus in communities, which is especially important before a pandemic vaccine becomes widely available. NPIs, also known as community mitigation measures, are actions that persons and communities can take to help slow the spread of respiratory virus infections, including seasonal and pandemic influenza viruses.These guidelines replace the 2007 Interim Pre-pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States - Early, Targeted, Layered Use of Nonpharmaceutical Interventions (https://stacks.cdc.gov/view/cdc/11425). Several elements remain unchanged from the 2007 guidance, which described recommended NPIs and the supporting rationale and key concepts for the use of these interventions during influenza pandemics. NPIs can be phased in, or layered, on the basis of pandemic severity and local transmission patterns over time. Categories of NPIs include personal protective measures for everyday use (e.g., voluntary home isolation of ill persons, respiratory etiquette, and hand hygiene); personal protective measures reserved for influenza pandemics (e.g., voluntary home quarantine of exposed household members and use of face masks in community settings when ill); community measures aimed at increasing social distancing (e.g., school closures and dismissals, social distancing in workplaces, and postponing or cancelling mass gatherings); and environmental measures (e.g., routine cleaning of frequently touched surfaces).Several new elements have been incorporated into the 2017 guidelines. First, to support updated recommendations on the use of NPIs, the latest scientific evidence available since the influenza A (H1N1)pdm09 pandemic has been added. Second, a summary of lessons learned from the 2009 H1N1 pandemic response is presented to underscore the importance of broad and flexible prepandemic planning. Third, a new section on community engagement has been included to highlight that the timely and effective use of NPIs depends on community acceptance and active participation. Fourth, to provide new or updated pandemic assessment and planning tools, the novel influenza virus pandemic intervals tool, the Influenza Risk Assessment Tool, the Pandemic Severity Assessment Framework, and a set of prepandemic planning scenarios are described. Finally, to facilitate implementation of the updated guidelines and to assist states and localities with prepandemic planning and decision-making, this report links to six supplemental prepandemic NPI planning guides for different community settings that are available online (https://www.cdc.gov/nonpharmaceutical-interventions).
Collapse
Affiliation(s)
- Noreen Qualls
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
| | | | - Neha Kanade
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia.,Eagle Medical Services, San Antonio, Texas
| | - Narue Wright-Jegede
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia.,Karna, Atlanta, Georgia
| | - Stephanie Dopson
- Division of State and Local Readiness, Office of Public Health Preparedness and Response, CDC, Atlanta, Georgia
| | - Matthew Biggerstaff
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
| | - Carrie Reed
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
| | - Amra Uzicanin
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
| | | |
Collapse
|
3
|
Napoli C, Fabiani M, Rizzo C, Barral M, Oxford J, Cohen J, Niddam L, Goryński P, Pistol A, Lionis C, Briand S, Nicoll A, Penttinen P, Gauci C, Bounekkar A, Bonnevay S, Beresniak A. Assessment of human influenza pandemic scenarios in Europe. ACTA ACUST UNITED AC 2015; 20:29-38. [PMID: 25719965 DOI: 10.2807/1560-7917.es2015.20.7.21038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- C Napoli
- Istituto Superiore di Sanita (ISS), Rome, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Feret V, Naud J, Harambat J, Malato L, Fleury H, Fayon M. [Viral epidemiology and clinical severity during the peak of the influenza A(H1N1) variant epidemic in febrile respiratory diseases of children]. Arch Pediatr 2014; 21:709-15. [PMID: 24947110 PMCID: PMC7127584 DOI: 10.1016/j.arcped.2014.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 04/01/2014] [Accepted: 04/17/2014] [Indexed: 12/05/2022]
Abstract
En mars 2009, un nouveau virus a fait émergence, le virus Influenzae A(H1N1) variant. Nous avons voulu en étudier la répercussion médicale. Objectifs Définir la prévalence virale dans les atteintes respiratoires fébriles hospitalisées de l’enfant en période d’épidémie grippale A(H1N1) variant et déterminer les caractéristiques cliniques, paracliniques et évolutives liées aux virus identifiés. Méthodes Il s’est agi d’une étude épidémiologique, prospective, monocentrique menée à l’hôpital des Enfants du centre hospitalier universitaire de Bordeaux (Aquitaine, France) pendant l’épidémie grippale du 23 novembre au 20 décembre 2009 inclus. Tous les enfants hospitalisés pour atteinte respiratoire fébrile ont été inclus. Résultats Soixante-treize enfants ont été inclus. Une identification virale a été possible dans 52 % des cas, incluant 23 % de A(H1N1) variant [A(H1N1)v] et 29 % d’autres identifications dont 22 % de virus respiratoires syncitiaux. Une seule co-infection a été observée entre le virus [A(H1N1)v] et un pool viral (adénovirus ou virus para-influenzae ou bocavirus). Il n’existait pas de différence significative concernant l’âge, le sexe ou les facteurs de risque de gravité en fonction des virus identifiés. Concernant le virus [A(H1N1)v], les symptômes les plus fréquents étaient l’altération de l’état général, la toux, les atteintes oto-rhino-laryngologiques et les anomalies de la fréquence respiratoire, avec significativement moins de signes de lutte et d’anomalie auscultatoire mais plus de convulsions. Sur le plan paraclinique, il n’y avait pas de différence significative entre les groupes. Évolution et prise en charge ont été comparables. Conclusion Une faible prédominance du virus [A(H1N1)v] a été notée pendant l’épidémie grippale en Aquitaine dans les atteintes respiratoires fébriles justifiant une hospitalisation. Les caractéristiques cliniques, paracliniques et évolutives étaient peu spécifiques. L’ensemble de ces éléments n’a pas révélé de gravité particulière liée au virus [A(H1N1)v].
Collapse
Affiliation(s)
- V Feret
- Département de pédiatrie médicale, hôpital des Enfants, CHU Pellegrin, place Amélie-Rabat-Léon, 33076 Bordeaux cedex, France.
| | - J Naud
- Département de pédiatrie médicale, hôpital des Enfants, CHU Pellegrin, place Amélie-Rabat-Léon, 33076 Bordeaux cedex, France
| | - J Harambat
- Département de pédiatrie médicale, hôpital des Enfants, CHU Pellegrin, place Amélie-Rabat-Léon, 33076 Bordeaux cedex, France
| | - L Malato
- Service de virologie, CHU Pellegrin, 33076 Bordeaux cedex, France
| | - H Fleury
- Service de virologie, CHU Pellegrin, 33076 Bordeaux cedex, France
| | - M Fayon
- Service de virologie, CHU Pellegrin, 33076 Bordeaux cedex, France; Centre d'investigation clinique Inserm (CIC 0005), CHU de Bordeaux, 33076 Bordeaux, France
| |
Collapse
|
5
|
Salez N, Nougairede A, Ninove L, Zandotti C, de Lamballerie X, Charrel RN. Xpert Flu for point-of-care diagnosis of human influenza in industrialized countries. Expert Rev Mol Diagn 2014; 14:411-8. [PMID: 24707995 DOI: 10.1586/14737159.2014.901152] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Respiratory infections, particularly those caused by influenza viruses, represent the third-most important cause of death in the world due to infectious diseases. Nevertheless, despite the enormous publicity attracted by epidemics due to these viruses, laboratory diagnosis, documentation and recording of respiratory diseases is still unsatisfactory. Available diagnostic tests capable of providing results rapidly are either limited and insufficiently sensitive or highly sensitive and specific but insufficiently rapid. Considerable investment and research efforts have been made towards the development of new diagnostics for influenza A and B viruses and the Xpert(®) Flu assay (Cepheid(®), CA, USA) has emerged as one of the most promising. In this article, we review current knowledge of the Xpert Flu test, discuss its potential value as a point-of-care test and outline the potential leads for future development.
Collapse
Affiliation(s)
- Nicolas Salez
- Aix Marseille Université, IRD French Institute of Research for Development, EHESP French School of Public Health, EPV UMR_D 190 "Emergence des Pathologies Virales", and IHU Méditerranée Infection, APHM Public Hospitals of Marseille 13385, Marseille, France
| | | | | | | | | | | |
Collapse
|
6
|
Lapidus N, de Lamballerie X, Salez N, Setbon M, Delabre RM, Ferrari P, Moyen N, Gougeon ML, Vely F, Leruez-Ville M, Andreoletti L, Cauchemez S, Boëlle PY, Vivier E, Abel L, Schwarzinger M, Legeas M, Le Cann P, Flahault A, Carrat F. Factors associated with post-seasonal serological titer and risk factors for infection with the pandemic A/H1N1 virus in the French general population. PLoS One 2013; 8:e60127. [PMID: 23613718 PMCID: PMC3629047 DOI: 10.1371/journal.pone.0060127] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 02/22/2013] [Indexed: 12/16/2022] Open
Abstract
The CoPanFlu-France cohort of households was set up in 2009 to study the risk factors for infection by the pandemic influenza virus (H1N1pdm) in the French general population. The authors developed an integrative data-driven approach to identify individual, collective and environmental factors associated with the post-seasonal serological H1N1pdm geometric mean titer, and derived a nested case-control analysis to identify risk factors for infection during the first season. This analysis included 1377 subjects (601 households). The GMT for the general population was 47.1 (95% confidence interval (CI): 45.1, 49.2). According to a multivariable analysis, pandemic vaccination, seasonal vaccination in 2009, recent history of influenza-like illness, asthma, chronic obstructive pulmonary disease, social contacts at school and use of public transports by the local population were associated with a higher GMT, whereas history of smoking was associated with a lower GMT. Additionally, young age at inclusion and risk perception of exposure to the virus at work were identified as possible risk factors, whereas presence of an air humidifier in the living room was a possible protective factor. These findings will be interpreted in light of the longitudinal analyses of this ongoing cohort.
Collapse
Affiliation(s)
- Nathanael Lapidus
- Institut National de la Santé et de la Recherche Médicale, UMR-S 707, Paris, France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Glatman-Freedman A, Portelli I, Jacobs SK, Mathew JI, Slutzman JE, Goldfrank LR, Smith SW. Attack rates assessment of the 2009 pandemic H1N1 influenza A in children and their contacts: a systematic review and meta-analysis. PLoS One 2012; 7:e50228. [PMID: 23284603 PMCID: PMC3523802 DOI: 10.1371/journal.pone.0050228] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 10/18/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The recent H1N1 influenza A pandemic was marked by multiple reports of illness and hospitalization in children, suggesting that children may have played a major role in the propagation of the virus. A comprehensive detailed analysis of the attack rates among children as compared with their contacts in various settings is of great importance for understanding their unique role in influenza pandemics. METHODOLOGY/PRINCIPAL FINDINGS We searched MEDLINE (PubMed) and Embase for published studies reporting outbreak investigations with direct measurements of attack rates of the 2009 pandemic H1N1 influenza A among children, and quantified how these compare with those of their contacts. We identified 50 articles suitable for review, which reported school, household, travel and social events. The selected reports and our meta-analysis indicated that children had significantly higher attack rates as compared to adults, and that this phenomenon was observed for both virologically confirmed and clinical cases, in various settings and locations around the world. The review also provided insight into some characteristics of transmission between children and their contacts in the various settings. CONCLUSION/SIGNIFICANCE The consistently higher attack rates of the 2009 pandemic H1N1 influenza A among children, as compared to adults, as well as the magnitude of the difference is important for understanding the contribution of children to disease burden, for implementation of mitigation strategies directed towards children, as well as more precise mathematical modeling and simulation of future influenza pandemics.
Collapse
Affiliation(s)
- Aharona Glatman-Freedman
- Department of Family and Community Medicine, New York Medical College, Valhalla, New York, United States of America.
| | | | | | | | | | | | | |
Collapse
|
8
|
Abstract
In May 2009, the onset of pandemic influenza A (H1N1) began in Buenos Aires schools and a containment program was implemented. We report the first 191 school-aged cases. Influenza (H1N1) was a mild disease in children. Oseltamivir was well tolerated and resulted in a significantly reduced duration of symptoms in this group. Oseltamivir was also effective at preventing secondary cases.
Collapse
|
9
|
Clinical and Epidemiologic Characteristics of Hospitalized Patients with 2009 H1N1 Influenza Infection. INFLUENZA RESEARCH AND TREATMENT 2012; 2012:603989. [PMID: 23074669 PMCID: PMC3447285 DOI: 10.1155/2012/603989] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 02/08/2012] [Accepted: 02/11/2012] [Indexed: 11/18/2022]
Abstract
Objective. 2009 H1N1 virus is a new virus that was firstly detected in April 2009. This virus spreads from human to human and causes a worldwide disease. This paper aimed to review the clinical and epidemiological properties of patients with 2009 H1N1 influenza who were hospitalized and monitored at Eskisehir Osmangazi University Faculty of Medicine Hospital. Setting. A 1000-bed teaching hospital in Eskisehir, Turkey. Patients-Methods. Between 05 November 2009–01 February 2010, 106 patients with 2009 H1N1 influenza, who were hospitalized, were prospectively evaluated. Results. Out of 106 patients who were hospitalized and monitored, 99 (93.4%) had fever, 86 (81.1%) had cough, 48 (45.3%) had shortness of breath, 47 (44.3%) had sore throat, 38 (35.8%) had body pain, 30 (28.3%) had rhinorrhea, 17 (16%) had vomiting, 15 (14.2%) had headache, and 14 (13.2%) had diarrhea. When the patients were examined in terms of risk factors for severe disease, 83 (78.3%) patients had at least one risk factor. During clinical monitoring, pneumonia was the most frequent complication with a rate of 66%. While 47.2% of the patients were monitored in intensive care unit, 34% of them required mechanical ventilation support. Conclusion. Patients with 2009 H1N1 influenza, who were hospitalized and monitored, should be carefully monitored and treated.
Collapse
|
10
|
Šubelj V, Prosenc K, Sočan M. Seroprevalence study of antibodies against influenza A(H1N1) 2009 virus after the second pandemic wave in Slovenia. Wien Klin Wochenschr 2012; 124:177-80. [DOI: 10.1007/s00508-012-0126-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 12/21/2011] [Indexed: 11/30/2022]
|
11
|
Koita OA, Sangare L, Poudiougou B, Aboubacar B, Samake Y, Coulibaly T, Pronyk P, Salez N, Kieffer A, Ninove L, Flahault A, de Lamballerie X. A seroepidemiological study of pandemic A/H1N1(2009) influenza in a rural population of Mali. Clin Microbiol Infect 2012; 18:976-81. [PMID: 22221838 DOI: 10.1111/j.1469-0691.2011.03725.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The swine-origin H1N1 influenza A virus (pH1N1(2009)) started to circulate worldwide in 2009, and cases were notified in a number of sub-Saharan African countries. However, no epidemiological data allowing estimation of the epidemic burden were available in this region, preventing comprehensive comparisons with other parts of the world. The CoPanFlu-Mali programme studied a cohort of 202 individuals living in the rural commune of Dioro (southern central Mali). Pre-pandemic and post-pandemic paired sera (sampled in 2006 and April 2010, respectively) were tested by the haemagglutination inhibition (HI) method. Different estimates of pH1N1(2009) infection during the 2009 first epidemic wave were used (increased prevalence of HI titre of ≥1/40 or ≥1/80, seroconversions) and provided convergent attack rate values (12.4-14.9%), the highest values being observed in the 0-19-year age group (16.0-18.4%). In all age groups, pre-pandemic HI titres of ≥1/40 were associated with complete absence of seroconversion; and geometric mean titres were <15 in individuals who seroconverted and >20 in others. Important variations in seroconversion rate existed among the different villages investigated. Despite limitations resulting from the size and composition of the sample analysed, this study provides strong evidence that the impact of the pH1N1(2009) first wave was more important than previously believed, and that the determinants of the epidemic spread in sub-Saharan populations were quite different from those observed in developed countries.
Collapse
Affiliation(s)
- O A Koita
- Laboratory of Applied Molecular Biology, Faculty of Science and Techniques, University of Bamako, Bamako, Mali
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Dellagi K, Rollot O, Temmam S, Salez N, Guernier V, Pascalis H, Gérardin P, Fianu A, Lapidus N, Naty N, Tortosa P, Boussaïd K, Jaffar-Banjee MC, Filleul L, Flahault A, Carrat F, Favier F, de Lamballerie X. Pandemic influenza due to pH1N1/2009 virus: estimation of infection burden in Reunion Island through a prospective serosurvey, austral winter 2009. PLoS One 2011; 6:e25738. [PMID: 21980532 PMCID: PMC3183080 DOI: 10.1371/journal.pone.0025738] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 09/11/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To date, there is little information that reflects the true extent of spread of the pH1N1/2009v influenza pandemic at the community level as infection often results in mild or no clinical symptoms. This study aimed at assessing through a prospective study, the attack rate of pH1N1/2009 virus in Reunion Island and risk factors of infection, during the 2009 season. METHODOLOGY/PRINCIPAL FINDINGS A serosurvey was conducted during the 2009 austral winter, in the frame of a prospective population study. Pairs of sera were collected from 1687 individuals belonging to 772 households, during and after passage of the pandemic wave. Antibodies to pH1N1/2009v were titered using the hemagglutination inhibition assay (HIA) with titers ≥ 1/40 being considered positive. Seroprevalence during the first two weeks of detection of pH1N1/2009v in Reunion Island was 29.8% in people under 20 years of age, 35.6% in adults (20-59 years) and 73.3% in the elderly (≥ 60 years) (P<0.0001). Baseline corrected cumulative incidence rates, were 42.9%, 13.9% and 0% in these age groups respectively (P<0.0001). A significant decline in antibody titers occurred soon after the passage of the epidemic wave. Seroconversion rates to pH1N1/2009 correlated negatively with age: 63.2%, 39.4% and 16.7%, in each age group respectively (P<0.0001). Seroconversion occurred in 65.2% of individuals who were seronegative at inclusion compared to 6.8% in those who were initially seropositive. CONCLUSIONS Seroincidence of pH1N1/2009v infection was three times that estimated from clinical surveillance, indicating that almost two thirds of infections occurring at the community level have escaped medical detection. People under 20 years of age were the most affected group. Pre-epidemic titers ≥ 1/40 prevented seroconversion and are likely protective against infection. A concern was raised about the long term stability of the antibody responses.
Collapse
Affiliation(s)
- Koussay Dellagi
- GIS CRVOI, Centre de Recherche et de Veille sur les Maladies Emergentes dans l'Océan Indien, Saint-Denis, La Réunion.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Thontiravong A, Tantilertcharoen R, Tuanudom R, Sreta D, Thanawongnuwech R, Amonsin A, Oraveerakul K, Kitikoon P. Single-step multiplex reverse transcription polymerase chain reaction assay for detection and differentiation of the 2009 H1N1 Influenza A virus pandemic in Thai swine populations. J Vet Diagn Invest 2011; 23:1017-21. [PMID: 21908367 DOI: 10.1177/1040638711416620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A recently emerged H1N1 Influenza A virus (pandemic H1N1 (pH1N1)) with a Swine influenza virus (SIV) genetic background spread globally from human-to-human causing the first influenza virus pandemic of the 21st century. In a short period, reverse zoonotic cases in pigs followed by a widespread of the virus in the pig population were documented. The implementation of effective control strategies, rapid diagnosis, and differentiation of such virus from endemically circulating SIV in the various swine populations of the world is needed. To address the problem, a multiplex reverse transcription polymerase chain reaction assay utilizing a combination of the PB1, H1, and N1 primers that can rapidly and simultaneously subtype and screen for the presence of pH1N1 virus infection in Thai pigs was developed. The assay had 100% specificity and did not amplify genetic material from other subtypes of SIV, seasonal H1N1 human influenza (huH1N1) virus, highly pathogenic influenza H5N1 virus, and other important swine respiratory viral pathogens. The assay was able to both detect and subtype pH1N1 virus as low as 0.1-50% tissue culture infective doses/ml (TCID(50)/ml). The assay was used to screen 175 clinical samples obtained from SIV suspected cases, of which 6 samples were pH1N1 positive and were confirmed through virus isolation and whole genome sequencing. The results of the study suggested that the assay would be useful for the rapid diagnosis of pH1N1 in suspected Thai swineherds, where genetics of the endemically circulating SIV differ from the strains circulating in North American and European herds.
Collapse
Affiliation(s)
- Aunyaratana Thontiravong
- Emerging and Re-emerging Infectious Diseases in Animals Research Unit, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Schnepf N, Resche-Rigon M, Chaillon A, Scemla A, Gras G, Semoun O, Taboulet P, Molina JM, Simon F, Goudeau A, LeGoff J. High burden of non-influenza viruses in influenza-like illness in the early weeks of H1N1v epidemic in France. PLoS One 2011; 6:e23514. [PMID: 21858150 PMCID: PMC3157400 DOI: 10.1371/journal.pone.0023514] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Accepted: 07/19/2011] [Indexed: 11/18/2022] Open
Abstract
Background Influenza-like illness (ILI) may be caused by a variety of pathogens. Clinical observations are of little help to recognise myxovirus infection and implement appropriate prevention measures. The limited use of molecular tools underestimates the role of other common pathogens. Objectives During the early weeks of the 2009–2010 flu pandemic, a clinical and virological survey was conducted in adult and paediatric patients with ILI referred to two French University hospitals in Paris and Tours. Aims were to investigate the different pathogens involved in ILI and describe the associated symptoms. Methods H1N1v pandemic influenza diagnosis was performed with real time RT-PCR assay. Other viral aetiologies were investigated by the molecular multiplex assay RespiFinder19®. Clinical data were collected prospectively by physicians using a standard questionnaire. Results From week 35 to 44, endonasal swabs were collected in 413 patients. Overall, 68 samples (16.5%) were positive for H1N1v. In 13 of them, other respiratory pathogens were also detected. Among H1N1v negative samples, 213 (61.9%) were positive for various respiratory agents, 190 in single infections and 23 in mixed infections. The most prevalent viruses in H1N1v negative single infections were rhinovirus (62.6%), followed by parainfluenza viruses (24.2%) and adenovirus (5.3%). 70.6% of H1N1v cases were identified in patients under 40 years and none after 65 years. There was no difference between clinical symptoms observed in patients infected with H1N1v or with other pathogens. Conclusion Our results highlight the high frequency of non-influenza viruses involved in ILI during the pre-epidemic period of a flu alert and the lack of specific clinical signs associated with influenza infections. Rapid diagnostic screening of a large panel of respiratory pathogens may be critical to define and survey the epidemic situation and to provide critical information for patient management.
Collapse
Affiliation(s)
- Nathalie Schnepf
- Université Paris Diderot, Sorbonne Paris Cité, Microbiology Department, Saint-Louis Hospital, APHP, Paris, France
- François Rabelais University, Microbiology Department, Bretonneau Hospital, CHRU Tours, France
| | - Matthieu Resche-Rigon
- Université Paris Diderot, Sorbonne Paris Cité, Biostatistics Department, Saint-Louis Hospital, APHP, Paris, France
| | - Antoine Chaillon
- François Rabelais University, Microbiology Department, Bretonneau Hospital, CHRU Tours, France
| | - Anne Scemla
- Université Paris Diderot, Sorbonne Paris Cité, Infectious Diseases Department, Saint-Louis Hospital, APHP, Paris, France
| | - Guillaume Gras
- Internal Medicine and Infectious Diseases Departement, Bretonneau Hospital, CHRU Tours, France
| | - Oren Semoun
- Université Paris Diderot, Sorbonne Paris Cité, Biostatistics Department, Saint-Louis Hospital, APHP, Paris, France
| | - Pierre Taboulet
- Emergency Department, Saint-Louis Hospital, APHP, Paris, France
| | - Jean-Michel Molina
- Université Paris Diderot, Sorbonne Paris Cité, Infectious Diseases Department, Saint-Louis Hospital, APHP, Paris, France
| | - François Simon
- Université Paris Diderot, Sorbonne Paris Cité, Microbiology Department, Saint-Louis Hospital, APHP, Paris, France
- Inserm U941, Institut Universitaire d'Hématologie, Paris, France
| | - Alain Goudeau
- François Rabelais University, Microbiology Department, Bretonneau Hospital, CHRU Tours, France
| | - Jérôme LeGoff
- Université Paris Diderot, Sorbonne Paris Cité, Microbiology Department, Saint-Louis Hospital, APHP, Paris, France
- Inserm U941, Institut Universitaire d'Hématologie, Paris, France
- * E-mail:
| |
Collapse
|
15
|
Ninove L, Nougairede A, Gazin C, Zandotti C, Drancourt M, de Lamballerie X, Charrel RN. Comparative detection of enterovirus RNA in cerebrospinal fluid: GeneXpert system vs. real-time RT-PCR assay. Clin Microbiol Infect 2011; 17:1890-4. [PMID: 21848972 DOI: 10.1111/j.1469-0691.2011.03487.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Enteroviruses (EVs) constitute the most common cause of aseptic meningitis in both children and adults. Molecular techniques have now been recognized as the reference standard for the diagnosis of EV infections, and the rapidity of the molecular diagnosis of EV meningitis has been shown to be a determining factor in the management of patients. The rapid documentation of EV RNA in cerebrospinal fluid (CSF) is key to adapting patient management and the therapeutic regimen. To shorten the time needed for virological documentation, we implemented EV RNA detection in two point-of-care (POC) laboratories. Here, we present the results of the POC detection of EV RNA with the Xpert EV kit on the GeneXpert integrated system, and a comparison with the real-time RT-PCR (rtRT-PCR) assay routinely used in the core virology laboratory. From January to September 2009, a total of 310 CSF samples were tested. The rtRT-PCR gave 81 positive, 225 negative and four 'indeterminate' results. POC results were concordant in 81.6% (253/310). Most of the discrepancies consisted of 'indeterminate' results at the POC level (16%). Calculated performances (excluding the indeterminate results) of the Xpert EV kit on the GeneXpert system in POC settings were 100%, 98.9%, 97.6% and 100% for Sensibility, Specificity, positive predictive value and negative predictive value, respectively. Taken together, these results indicate that the implementation of POC detection of EV RNA can provide robust results in <4 h, and may have a significant impact on patient management, therapeutic attitude, and hospitalization costs.
Collapse
Affiliation(s)
- L Ninove
- Laboratory of Clinical Microbiology, AP-HM Timone, Université de la Méditerranée, Marseille, France.
| | | | | | | | | | | | | |
Collapse
|
16
|
Cohen-Bacrie S, Ninove L, Nougairède A, Charrel R, Richet H, Minodier P, Badiaga S, Noël G, La Scola B, de Lamballerie X, Drancourt M, Raoult D. Revolutionizing clinical microbiology laboratory organization in hospitals with in situ point-of-care. PLoS One 2011; 6:e22403. [PMID: 21811599 PMCID: PMC3139639 DOI: 10.1371/journal.pone.0022403] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 06/21/2011] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Clinical microbiology may direct decisions regarding hospitalization, isolation and anti-infective therapy, but it is not effective at the time of early care. Point-of-care (POC) tests have been developed for this purpose. METHODS AND FINDINGS One pilot POC-lab was located close to the core laboratory and emergency ward to test the proof of concept. A second POC-lab was located inside the emergency ward of a distant hospital without a microbiology laboratory. Twenty-three molecular and immuno-detection tests, which were technically undemanding, were progressively implemented, with results obtained in less than four hours. From 2008 to 2010, 51,179 tests yielded 6,244 diagnoses. The second POC-lab detected contagious pathogens in 982 patients who benefited from targeted isolation measures, including those undertaken during the influenza outbreak. POC tests prevented unnecessary treatment of patients with non-streptococcal tonsillitis (n = 1,844) and pregnant women negative for Streptococcus agalactiae carriage (n = 763). The cerebrospinal fluid culture remained sterile in 50% of the 49 patients with bacterial meningitis, therefore antibiotic treatment was guided by the molecular tests performed in the POC-labs. With regard to enterovirus meningitis, the mean length-of-stay of infected patients over 15 years old significantly decreased from 2008 to 2010 compared with 2005 when the POC was not in place (1.43±1.09 versus 2.91±2.31 days; p = 0.0009). Altogether, patients who received POC tests were immediately discharged nearly thrice as often as patients who underwent a conventional diagnostic procedure. CONCLUSIONS The on-site POC-lab met physicians' needs and influenced the management of 8% of the patients that presented to emergency wards. This strategy might represent a major evolution of decision-making regarding the management of infectious diseases and patient care.
Collapse
Affiliation(s)
- Stéphan Cohen-Bacrie
- Fédération de Microbiologie Clinique, Assistance Publique des Hôpitaux de Marseille-Pôle des Maladies Infectieuses, Hôpital la Timone, Marseille, France
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, CNRS-UMR 6236, IRD 198, IFR 48, Faculté de Médecine, Université de la Méditerranée, Marseille, France
| | - Laetitia Ninove
- Fédération de Microbiologie Clinique, Assistance Publique des Hôpitaux de Marseille-Pôle des Maladies Infectieuses, Hôpital la Timone, Marseille, France
- Unité des Virus Emergents, UMR190, IRD and Université de la Méditerranée, Marseille, France
| | - Antoine Nougairède
- Fédération de Microbiologie Clinique, Assistance Publique des Hôpitaux de Marseille-Pôle des Maladies Infectieuses, Hôpital la Timone, Marseille, France
- Unité des Virus Emergents, UMR190, IRD and Université de la Méditerranée, Marseille, France
| | - Rémi Charrel
- Fédération de Microbiologie Clinique, Assistance Publique des Hôpitaux de Marseille-Pôle des Maladies Infectieuses, Hôpital la Timone, Marseille, France
- Unité des Virus Emergents, UMR190, IRD and Université de la Méditerranée, Marseille, France
| | - Hervé Richet
- Fédération de Microbiologie Clinique, Assistance Publique des Hôpitaux de Marseille-Pôle des Maladies Infectieuses, Hôpital la Timone, Marseille, France
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, CNRS-UMR 6236, IRD 198, IFR 48, Faculté de Médecine, Université de la Méditerranée, Marseille, France
| | - Philippe Minodier
- Service d'Accueil des Urgences, Assistance Publique des Hôpitaux de Marseille, Hôpital Nord, Marseille, France
| | - Sékéné Badiaga
- Service d'Accueil des Urgences, Assistance Publique des Hôpitaux de Marseille, Hôpital Nord, Marseille, France
| | - Guilhem Noël
- Service d'Accueil des Urgences, Assistance Publique des Hôpitaux de Marseille, Hôpital Nord, Marseille, France
- Observatoire Régional des Urgences Provence-Alpes-Côte d'Azur, Hyères, France
| | - Bernard La Scola
- Fédération de Microbiologie Clinique, Assistance Publique des Hôpitaux de Marseille-Pôle des Maladies Infectieuses, Hôpital la Timone, Marseille, France
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, CNRS-UMR 6236, IRD 198, IFR 48, Faculté de Médecine, Université de la Méditerranée, Marseille, France
| | - Xavier de Lamballerie
- Fédération de Microbiologie Clinique, Assistance Publique des Hôpitaux de Marseille-Pôle des Maladies Infectieuses, Hôpital la Timone, Marseille, France
- Unité des Virus Emergents, UMR190, IRD and Université de la Méditerranée, Marseille, France
| | - Michel Drancourt
- Fédération de Microbiologie Clinique, Assistance Publique des Hôpitaux de Marseille-Pôle des Maladies Infectieuses, Hôpital la Timone, Marseille, France
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, CNRS-UMR 6236, IRD 198, IFR 48, Faculté de Médecine, Université de la Méditerranée, Marseille, France
| | - Didier Raoult
- Fédération de Microbiologie Clinique, Assistance Publique des Hôpitaux de Marseille-Pôle des Maladies Infectieuses, Hôpital la Timone, Marseille, France
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, CNRS-UMR 6236, IRD 198, IFR 48, Faculté de Médecine, Université de la Méditerranée, Marseille, France
- * E-mail:
| |
Collapse
|
17
|
Holmes EC, Ghedin E, Halpin RA, Stockwell TB, Zhang XQ, Fleming R, Davey R, Benson CA, Mehta S, Taplitz R, Liu YT, Brouwer KC, Wentworth DE, Lin X, Schooley RT. Extensive geographical mixing of 2009 human H1N1 influenza A virus in a single university community. J Virol 2011; 85:6923-9. [PMID: 21593168 PMCID: PMC3126550 DOI: 10.1128/jvi.00438-11] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 05/04/2011] [Indexed: 01/20/2023] Open
Abstract
Despite growing interest in the molecular epidemiology of influenza virus, the pattern of viral spread within individual communities remains poorly understood. To determine the phylogeography of influenza virus in a single population, we examined the spatial diffusion of H1N1/09 influenza A virus within the student body of the University of California, San Diego (UCSD), sampling for a 1-month period between October and November 2009. Despite the highly focused nature of our study, an analysis of complete viral genome sequences revealed between 24 and 33 independent introductions of H1N1/09 into the UCSD community, comprising much of the global genetic diversity in this virus. These data were also characterized by a relatively low level of on-campus transmission as well as extensive spatial mixing, such that there was little geographical clustering by either student residence or city ZIP code. Most notably, students experiencing illness on the same day and residing in the same dorm possessed phylogenetically distinct lineages. H1N1/09 influenza A virus is therefore characterized by a remarkable spatial fluidity, which is likely to impede community-based methods for its control, including class cancellations, quarantine, and chemoprophylaxis.
Collapse
Affiliation(s)
- Edward C Holmes
- Department of Biology, The Pennsylvania State University, University Park, PA 16802, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Rørtveit S, Hunskår S, Wensaas KA, Simonsen KA, Rørtveit G. [The influenza pandemic in a Norwegian municipality autumn 2009]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2011; 131:675-9. [PMID: 21494301 DOI: 10.4045/tidsskr.10.0858] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND In April 2009 the World Health Organization (WHO) declared that spreading of a new influenza A(H1N1) virus had reached epidemic proportions, and on June 11, 2009 they declared that the world was in fact facing a pandemic. In Norway the influenza pandemic was the cause of much activity from health authorities and all levels of the health services. This report concerns pandemic-related work within clinical and community medicine in a municipality in western Norway. MATERIAL AND METHODS All contacts between the general practitioners (GPs) and patients with influenza-like disease in Austevoll municipality were recorded for the second half of 2009. The lead public health nurse recorded vaccination activity systematically. Absence from secondary school in the municipality was recorded and the Medical Health Officer recorded all pandemic-related activities. RESULTS 141 patients living in the municipality (3.2 % of the population) contacted the GP for influenza-like disease. Most cases occurred during weeks 43-47. A large majority of the encounters with the GP during these weeks were with patients below 20 years of age, whereas the age distribution was much more diverse at other points in time. Absence from secondary school was also highest in weeks 43-47. 54 % of the municipality's inhabitants were vaccinated. At the end of the main wave of the epidemic, vaccination coverage had reached 28 %. The Medical Health Officer had a large workload, especially during the main wave. INTERPRETATION The influenza epidemic in 2009 hit Austevoll municipality in weeks 43-47. Mass vaccination was started too late to have a major influence on the epidemic. Systematic mapping of the epidemic on a municipal level is a useful supplement to the national surveillance.
Collapse
|
19
|
Delangue J, Salez N, Ninove L, Kieffer A, Zandotti C, Seston M, Lina B, Nougairede A, Charrel R, Flahault A, de Lamballerie X. Serological study of the 2009 pandemic due to influenza A H1N1 in the metropolitan French population. Clin Microbiol Infect 2011; 18:177-83. [PMID: 21635661 DOI: 10.1111/j.1469-0691.2011.03545.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We looked for evidence of antibodies to the 2009 influenza A/H1N1 pandemic virus in panels of sera from individuals living in metropolitan France, obtained either before, during or after the epidemic, using standard haemagglutination inhibition and microneutralization tests. The difference between seroprevalence values measured in post- and pre-epidemic panels was used as an estimate of seroconversion rate in different age groups (23.4% (0-24 years, age-group 0); 16.5% (25-34); 7.9% (35-44); 7.2% (45-54); 1.6% (55-64); and 3.1% (>65)), confirming that the distribution of cases in different age groups was similar to that of the seasonal H1N1 virus. During the pre-pandemic period low-titre cross-reactive antibodies were present in a large proportion of the population (presumably acquired against seasonal H1N1) whereas cross-reactive antibodies were detected in individuals over the age of 65 years with significantly higher prevalence and serological titres (presumably acquired previously against Spanish flu-related H1N1 strains). Clinical data and analysis of post-pandemic seroprevalence showed that few of these latter patients were infected by the influenza virus during the epidemic. In contrast, the majority of both clinical cases and seroconversions were recorded in the 0-24 age group and a global inverse relationship between prevalence of antibodies to pH1N1 in the pre-pandemic period and rate of seroconversion was observed amongst age groups. Our results emphasize the complex relationships involved in antigenic reactivity to pandemic and seasonal H1N1 viral antigens; hence the difficulty in distinguishing between low-titre specific and cross-reactive antibodies, establishing precise seroprevalence numbers and fully understanding the relationship between previous immunity to seasonal viruses and protection against the novel variant.
Collapse
Affiliation(s)
- J Delangue
- Unité des Virus Emergents, UMR190 Université Aix-Marseille 2 and Institut de Recherche pour le Développement, Marseille, France
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Falchi A, Turbelin C, Andreoletti L, Arena C, Blanchon T, Bonmarin I, Hanslik T, Leruez-Ville M, De Lamballerie X, Carrat F. Nationwide surveillance of 18 respiratory viruses in patients with influenza-like illnesses: a pilot feasibility study in the French Sentinel Network. J Med Virol 2011; 83:1451-7. [PMID: 21638286 PMCID: PMC7166811 DOI: 10.1002/jmv.22113] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2011] [Indexed: 11/28/2022]
Abstract
The aim of the present study was to test the feasibility of integrating the diagnosis of 18 respiratory viruses into clinical surveillance of influenza‐like illness using a PCR‐DNA microarray detection assay. The study took place in the French Sentinel Network, a nationwide surveillance network of General Practitioners (GPs) representative of French GPs in terms age, location, and type of practice (urban/rural). Three virological laboratories also participated in the study. The study was planned for 5 weeks from January 25, 2010 to February 27, 2010. A subset of 150 Sentinel GPs, located in mainland France, was enrolled to collect clinical data and nasopharyngeal samples from every first patient of the week having a medical visit for influenza‐like illness defined as a sudden fever of 39°C or more with respiratory symptoms and myalgia. Sixty‐three GPs (42%) collected 103 samples while 87 GPs (58%) did not. GPs did not differ with respect to their age, gender, urban/rural distribution, or years of inscription in the Sentinel Network. Patients included were of a similar age and had similar vaccination characteristics, but were more frequently men than influenza‐like illness patients reported to the network during the study period. Sixty‐one viruses were detected from 56 of 96 (58%) interpretable samples. The respiratory viruses detected most frequently were metapneumovirus and respiratory syncytial virus. This study showed that virological diagnosis of 18 respiratory viruses can be combined with surveillance of clinical influenza‐like illness in general practice. Although feasibility has not been demonstrated yet, it will be evaluated over the winter of 2010–2011. J. Med. Virol. 83:1451–1457, 2011. © 2011 Wiley‐Liss, Inc.
Collapse
|
21
|
Jernigan DB, Lindstrom SL, Johnson JR, Miller JD, Hoelscher M, Humes R, Shively R, Brammer L, Burke SA, Villanueva JM, Balish A, Uyeki T, Mustaquim D, Bishop A, Handsfield JH, Astles R, Xu X, Klimov AI, Cox NJ, Shaw MW. Detecting 2009 pandemic influenza A (H1N1) virus infection: availability of diagnostic testing led to rapid pandemic response. Clin Infect Dis 2011; 52 Suppl 1:S36-43. [PMID: 21342897 DOI: 10.1093/cid/ciq020] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Diagnostic tests for detecting emerging influenza virus strains with pandemic potential are critical for directing global influenza prevention and control activities. In 2008, the Centers for Disease Control and Prevention received US Food and Drug Administration approval for a highly sensitive influenza polymerase chain reaction (PCR) assay. Devices were deployed to public health laboratories in the United States and globally. Within 2 weeks of the first recognition of 2009 pandemic influenza H1N1, the Centers for Disease Control and Prevention developed and began distributing a new approved pandemic influenza H1N1 PCR assay, which used the previously deployed device platform to meet a >8-fold increase in specimen submissions. Rapid antigen tests were widely used by clinicians at the point of care; however, test sensitivity was low (40%-69%). Many clinical laboratories developed their own pandemic influenza H1N1 PCR assays to meet clinician demand. Future planning efforts should identify ways to improve availability of reliable testing to manage patient care and approaches for optimal use of molecular testing for detecting and controlling emerging influenza virus strains.
Collapse
Affiliation(s)
- D B Jernigan
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Noel G, Jachymczyk J, Uters M, Laporte R, Jurquet A, Parache C, Retornaz K, Viudes G, Minodier P. Valeurs des signes cliniques et d’un test de diagnostic rapide dans le diagnostic de la grippe A (H1N1) nouveau variant aux urgences pédiatriques. Arch Pediatr 2011; 18:497-504. [DOI: 10.1016/j.arcped.2011.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Revised: 01/05/2011] [Accepted: 02/18/2011] [Indexed: 11/25/2022]
|
23
|
Moss R, McCaw JM, McVernon J. Diagnosis and antiviral intervention strategies for mitigating an influenza epidemic. PLoS One 2011; 6:e14505. [PMID: 21346794 PMCID: PMC3033893 DOI: 10.1371/journal.pone.0014505] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Accepted: 12/10/2010] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Many countries have amassed antiviral stockpiles for pandemic preparedness. Despite extensive trial data and modelling studies, it remains unclear how to make optimal use of antiviral stockpiles within the constraints of healthcare infrastructure. Modelling studies informed recommendations for liberal antiviral distribution in the pandemic phase, primarily to prevent infection, but failed to account for logistical constraints clearly evident during the 2009 H1N1 outbreaks. Here we identify optimal delivery strategies for antiviral interventions accounting for logistical constraints, and so determine how to improve a strategy's impact. METHODS AND FINDINGS We extend an existing SEIR model to incorporate finite diagnostic and antiviral distribution capacities. We evaluate the impact of using different diagnostic strategies to decide to whom antivirals are delivered. We then determine what additional capacity is required to achieve optimal impact. We identify the importance of sensitive and specific case ascertainment in the early phase of a pandemic response, when the proportion of false-positive presentations may be high. Once a substantial percentage of ILI presentations are caused by the pandemic strain, identification of cases for treatment on syndromic grounds alone results in a greater potential impact than a laboratory-dependent strategy. Our findings reinforce the need for a decentralised system capable of providing timely prophylaxis. CONCLUSIONS We address specific real-world issues that must be considered in order to improve pandemic preparedness policy in a practical and methodologically sound way. Provision of antivirals on the scale proposed for an effective response is infeasible using traditional public health outbreak management and contact tracing approaches. The results indicate to change the transmission dynamics of an influenza epidemic with an antiviral intervention, a decentralised system is required for contact identification and prophylaxis delivery, utilising a range of existing services and infrastructure in a "whole of society" response.
Collapse
Affiliation(s)
- Robert Moss
- Vaccine and Immunisation Research Group, Murdoch Childrens Research Institute and Melbourne School of Population Health, The University of Melbourne, Parkville, Australia.
| | | | | |
Collapse
|
24
|
Models cannot predict future outbreaks: A/H1N1 virus, the paradigm. Eur J Epidemiol 2010; 26:183-6. [DOI: 10.1007/s10654-010-9533-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Accepted: 12/02/2010] [Indexed: 11/26/2022]
|
25
|
POC tests: From antigen detection to molecular methods. Future trends. J Clin Virol 2010; 49:304-5. [DOI: 10.1016/j.jcv.2010.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Accepted: 08/19/2010] [Indexed: 11/21/2022]
|
26
|
Detection of extensive cross-neutralization between pandemic and seasonal A/H1N1 Influenza Viruses using a pseudotype neutralization assay. PLoS One 2010; 5:e11036. [PMID: 20543954 PMCID: PMC2882952 DOI: 10.1371/journal.pone.0011036] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Accepted: 05/13/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cross-immunity between seasonal and pandemic A/H1N1 influenza viruses remains uncertain. In particular, the extent that previous infection or vaccination by seasonal A/H1N1 viruses can elicit protective immunity against pandemic A/H1N1 is unclear. METHODOLOGY/PRINCIPAL FINDINGS Neutralizing titers against seasonal A/H1N1 (A/Brisbane/59/2007) and against pandemic A/H1N1 (A/California/04/2009) were measured using an HIV-1-based pseudovirus neutralization assay. Using this highly sensitive assay, we found that a large fraction of subjects who had never been exposed to pandemic A/H1N1 express high levels of pandemic A/H1N1 neutralizing titers. A significant correlation was seen between neutralization of pandemic A/H1N1 and neutralization of a standard seasonal A/H1N1 strain. Significantly higher pandemic A/H1N1 neutralizing titers were measured in subjects who had received vaccination against seasonal influenza in 2008-2009. Higher pandemic neutralizing titers were also measured in subjects over 60 years of age. CONCLUSIONS/SIGNIFICANCE Our findings reveal that the extent of protective cross-immunity between seasonal and pandemic A/H1N1 influenza viruses may be more important than previously estimated. This cross-immunity could provide a possible explanation of the relatively mild profile of the recent influenza pandemic.
Collapse
|