Surveillance of COVID-19 and influenza A(H1N1) prevalence in China via medicine-based wastewater biomarkers

The simultaneous monitoring of individual or multiple diseases can be achieved by selecting therapeutic medicines used to treat the primary symptoms of the condition as biomarkers in wastewater. This study proposes a novel approach to monitor the prevalence of COVID-19 and influenza A (H1N1) by selecting nine medicines to serve as biomarkers, including three antipyretics, three antivirals, and three cough suppressants. To verify our approach, wastewater samples were collected from seventeen urban and five rural wastewater treatment plants (WWTPs) in a Chinese city over a period of one year. The use of antipyretics increased notably during the COVID-19 pandemic, while the consumption of antivirals for influenza A (H1N1) rose in the post-COVID-19 pandemic period, indicating a minor spike in the occurrence of influenza A (H1N1) after the COVID-19 pandemic. Fever is a significant symptom of COVID-19 and can serve as a reliable indicator of disease prevalence. Our research found that the prevalence of COVID-19 in urban areas was significantly higher (at 78.5 %, 95 % CI: 73.4 % - 83.9 %) than in rural areas (with a prevalence of 48.1 %, 95 % CI: 42.4 % - 53.8 %). The prevalence of COVID-19 in urban areas in this study was consistent with the data reported by the Chinese center for Disease Control and Prevention (82.4 %). Continuous monitoring of WWTPs in urban areas with fluctuating populations and complex demographics can provide early disease warning. Our results demonstrate the feasibility of evaluating community disease prevalence by selecting major therapeutic medicines as biomarkers in wastewater.

UV Inactivation of Common Pathogens and Surrogates under 222 Nm Irradiation from Krcl* Excimer

Germicidal ultraviolet (UV) devices have been widely used for pathogen disinfection in water, air, and on food and surfaces. Emerging UV technologies, like the krypton chloride (KrCl*) excimer emitting at 222 nm, are rapidly gaining popularity due to their minimal adverse health effects compared to conventional UV lamps emitting at 254 nm, opening opportunities for UV disinfection in occupied public spaces. In this study, inactivation of seven bacteria and five viruses, including waterborne, foodborne, and respiratory pathogens, was determined in a thin-film aqueous solution using a filtered KrCl* excimer emitting primarily at 222 nm. Our results show that the KrCl* excimer can effectively inactivate all tested bacteria and viruses, with most microorganisms achieving more than 4-log (99.99%) reduction with a UV dose of 10 mJ/cm² . Compared to conventional UV lamps, KrCl* excimer exhibited better disinfection performance for viruses but was less effective for bacteria. The relationships between UV sensitivities at 222 nm and 254 nm for bacteria and viruses were evaluated using regression analysis, resulting in factors that could be used to estimate the KrCl* excimer disinfection performance from well-documented UV kinetics using conventional 254 nm UV lamps. This study provides fundamental information for pathogen disinfection when employing KrCl* excimers.

Disease Surveillance: The Bedrock for Control and Prevention

How to cite this article: Krishna B. Disease Surveillance: The Bedrock for Control and Prevention. Indian J Crit Care Med 2021;25(7):745-746.

CCR5 Antagonist Maraviroc Inhibits Acute Exacerbation of Lung Inflammation Triggered by Influenza Virus in Cigarette Smoke-Exposed Mice

Influenza A virus (IAV) infection is a common cause of acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Since macrophage inflammatory protein 1 α, a chemokine that acts through CC-chemokine receptor (CCR)-5, appears elevated in COPD patients’ airways, we evaluated whether CCR5 antagonist Maraviroc could inhibit the exacerbated lung inflammatory response noted after IAV H1N1 infection in mice exposed to cigarette smoke (Cs). C57BL/6 mice, subjected or not to Cs inhalation for 11 days, were infected with H1N1 at day 7. Maraviroc (10 mg/kg) or dexamethasone (1 mg/kg) were given in a therapeutic schedule, followed by the analyses of lung function, survival rate, and inflammatory changes. As compared to mice subjected to Cs or H1N1 alone, the insult combination significantly worsened airway obstruction, neutrophil infiltration in the airways, and the survival rate. All changes were sensitive to Maraviroc but not dexamethasone. Maraviroc also reduced the accumulation of neutrophils and macrophages as well as CXCL1 production in the lung tissue, and serum levels of IL-6, whereas comparable viral titers in the lungs were noted in all infected groups. Collectively, these findings suggest that Maraviroc oral treatment could be an effective therapy for controlling acute exacerbations of respiratory diseases such as COPD.

Antiviral Activity of Fritillaria thunbergii Extract against Human Influenza Virus H1N1 (PR8) In Vitro, In Ovo and In Vivo

Influenza viruses cause respiratory diseases in humans and animals with high morbidity and mortality rates. Conventional anti-influenza drugs are reported to exert side effects and newly emerging viral strains tend to develop resistance to these commonly used agents. Fritillaria thunbergii (FT) is traditionally used as an expectorant for controlling airway inflammatory disorders. Here, we evaluated the therapeutic effects of FT extracts against influenza virus type A (H1N1) infection in vitro, in ovo, and in vivo. In the post-treatment assay, FT extracts showed high CC50 (7,500 µg/ml), indicating low toxicity, and exerted moderate antiviral effects compared to oseltamivir (SI 50.6 vs. 222) in vitro. Antiviral activity tests in ovo revealed strong inhibitory effects of both FT extract and oseltamivir against H1N1 replication in embryonated eggs. Notably, at a treatment concentration of 150 mg/kg, only half the group administered oseltamivir survived whereas the FT group showed 100% survival, clearly demonstrating the low toxicity of FT extracts. Consistent with these findings, FT-administered mice showed a higher survival rate with lower body weight reduction relative to the oseltamivir group upon treatment 24 h after viral infection. Our collective results suggest that FT extracts exert antiviral effects against influenza H1N1 virus without inducing toxicity in vitro, in ovo or in vivo, thereby supporting the potential utility of FT extract as a novel candidate therapeutic drug or supplement against influenza.

Antiviral activity of multifunctional composite based on TiO2-modified hydroxyapatite

An antiviral activity of TiO₂-modified hydroxyapatite composite (HA/TiO₂) had been investigated. The HA/TiO₂ composite (HA50:Ti50) was prepared by a solid state reaction method followed by calcination at 650 °C for 2 h. Phase formations and morphologies of the obtained HA/TiO₂ composite powders were determined using XRD and SEM. XRD result confirmed that HA/TiO₂ composite was successfully prepared. SEM revealed small crystals of anatase TiO₂ embedded in larger HA crystals. A strong antiviral activity against H1N1 Influenza A Virus was observed at 0.5 mg/ml concentration of the composite under the UV irradiation for 60 min. It showed the highest rate of reducing virus titer approximately more than 2 log/h. Results obtained from this study indicated that HA/TiO₂ composite could be a promising material to be used as antimicrobial filtration applications such as in face masks.

Epidemiology and Clinical Complication Patterns of Influenza A (H1N1 Virus) in Northern Saudi Arabia

The aim of the present study is to describe epidemiologic and clinical presentation, clinical complications and outcomes of patients diagnosed with influenza A infection (H1N1) during a one-year period. We retrospectively investigated 300 patients with influenza-like clinical presentation during the period January 2015 – January 2016 in King Khalid Hospital, Saudi Arabia. Fifty-four patients out of 300 (18%) were diagnosed with H1N1 virus infection; their age ranged from 7 months to 85 years, with a mean age of 25 years. Among them, 34 (63%) were males and 20 (37%) were females, with a M:F ratio of 1.70. The findings of this study show the great spread of influenza A outside the main holy cities of Saudi Arabia, and underline the absolute need for strict prevention strategies including vaccinations, public awareness and hygiene measures.

A Two Wave Analysis of Hospitalizations and Mortality from Seasonal and Pandemic 2009 A (H1N1) Influenza in Saurashtra, India: 2009-2011

BACKGROUND

During May 2009, India reported the confirmed case of 2009 A (H1N1) influenza reported and in August 2009, Saurashtra region made the first report.

AIM

We describe the clinico-epidemiological characteristics of patients who were hospitalized with 2009 A (H1N1) influenza infection and seasonal influenza in Saurashtra region.

SUBJECTS AND METHODS

A total of 1726 patients suffering from A (H1N1) influenza and seasonal influenza were admitted in the different hospitals of Rajkot city of Saurashtra region during September 2009-February 2011. Real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) testing was used to confirm the infection. The clinico-epidemiological features of the patients were closely monitored. Data were analyzed by Chi square or Fisher's exact test, using Epi Info software (version 3.5.1) of the Center for Disease Control (CDC).

RESULTS

Among the patients hospitalized due to influenza, 29.6% (511/1726) were laboratory confirmed cases of A (H1N1) influenza while the rest 70.4% (1215/1726) were cases of seasonal influenza. A median time of 5 days was observed from the onset of illness to laboratory confirmed diagnosis of A (H1N1) influenza. The median duration of hospital stay of such patients was 2-32 days. All admitted A (H1N1) influenza patients received Oseltamivir drug, but only 14.9% (76/511) received it within 2 days of onset of illness. 24.9% (127/511) of those admitted for A (H1N1) influenza died as compared to 5.3% (65/1215) of those suffering from seasonal influenza. The most common symptoms were cough, fever, sore throat and shortness of breath in both the groups of patients. The prevalence of any coexisting morbidity in those with A (H1N1) influenza was 31.3% (160/511) while in those with seasonal influenza it was 19.4% (236/1215). The common coexisting morbidities were hypertension, diabetes mellitus, chronic pulmonary diseases and pregnancy. Pneumonia was reported in 91% positive patients with chest radiography.

CONCLUSION

Though the clinico-epidemiological pattern of the A (H1N1) influenza patients were comparable to that of those suffering from seasonal influenza, a fivefold higher mortality was noted in A (H1N1) influenza patients. Hypertension, pregnancy, pneumonia on chest X-ray, and receiving antiviral treatment within 2 days of illness onset were mainly reported among A (H1N1) influenza patients.

A novel influenza A (H1N1) outbreak experience among residents of a long term-care facility in Saudi Arabia during 2010 seasonal flu circulation

The aim of this work was to describe and analyze an outbreak of novel 2009 influenza A (H1N1) among residents of a long-term care facility (LTCF) in Prince Mansour Military Hospital (PMMH), Taif, Saudi Arabia. These patients had been admitted to the LTCF months or years before the outbreak for several reasons, e.g. cerebral palsy, neurological deficits due to road traffic accidents with resultant handicap, chronic diseases associated with old age. An observational study was carried out to demonstrate and analyze the epidemiological characteristics (demographic factors, risk factors, and outcomes) associated with the outbreak in order to clarify which prevention and control measures had been taken and which recommendations were followed. During the period October 28 to November 11 2010, 21 LTCF residents were suspected to be clinically involved: fever ≥38°C with influenza-like illness (ILI). Age ranged from 9-91 years (mean 46±24.13); 62% were males. Among them, 12 (57%) were influenza A (H1N1) positive by reverse transcription polymerase chain reaction (RT-PCR). Mortality involved 2 (17%) of the A (H1N1) laboratory confirmed individuals. Implementation of the recommended infection control measures mitigated the transmission of infection to new individuals. The fulfillment of strict infection control measures could limit H1N1 infection among LTCF-PMMH patients. Routine influenza, including specific H1N1 immunization of all LTCF residents together with their healthcare staff, should be mandatory in those settings serving immunocompromised patients.

The Neurological Manifestations of H1N1 Influenza Infection; Diagnostic Challenges and Recommendations

BACKGROUND

World Health Organization declared pandemic phase of human infection with novel influenza A (H1N1) in April 2009. There are very few reports about the neurological complications of H1N1 virus infection in the literature. Occasionally, these complications are severe and even fatal in some individuals. The aims of this study were to report neurological complaints and/or complications associated with H1N1 virus infection.

METHODS

The medical files of all patients with H1N1 influenza infection admitted to a specified hospital in the city of , from October through November 2009 were reviewed. More information about the patients were obtained by phone calls to the patients or their care givers. All patients had confirmed H1N1 virus infection with real-time PCR assay.

RESULTS

Fifty-five patients with H1N1 infection were studied. Twenty-three patients had neurological signs and/or symptoms. Mild neurological complaints may be reported in up to 42% of patients infected by H1N1 virus. Severe neurological complications occurred in 9% of the patients. The most common neurological manifestations were headache, numbness and paresthesia, drowsiness and coma. One patient had a Guillain-Barre syndrome-like illness, and died in a few days. Another patient had focal status epilepticus and encephalopathy.

CONCLUSIONS

The H1N1 infection seems to have been quite mild with a self-limited course in much of the world, yet there appears to be a subset, which is severely affected. We recommend performing diagnostic tests for H1N1influenza virus in all patients with respiratory illness and neurological signs/symptoms. We also recommend initiating treatment with appropriate antiviral drugs as soon as possible in those with any significant neurological presentation accompanied with respiratory illness and flu-like symptoms.