Abstract
BackgroundAcute respiratory infections represent a serious public health issue worldwide but virological aetiologies of Influenza Like Illnesses (ILIs) remain largely unknown in developing countries. This study represents the first attempt to characterise viral aetiologies of ILIs in Bolivia.MethodsIt was performed in Santa Cruz city from January 2010 to September 2012, based on 564 naso-pharyngeal swabs collected in a National Reference Laboratory and real-time PCR techniques, viral cultures and phylogenetic analyses.Results50.2% of samples were positive for at least one virus with influenza viruses (Flu A: ~15%; Flu B: ~9%), rhinoviruses (~8%), coronaviruses (~5%) and hRSV (~4%) being the most frequently identified. The pattern of viral infections varied according to age groups. The elucidation rate was the highest (>60%) amongst patients under 10 yo and the lowest (<40%) amongst patients ≥60 yo. Nearly 3% of samples showed dual viral infections. Epidemiological peaks were associated with a predominant virus but generally included 30-50% of infections by different viruses. Unexpectedly, the frequency of influenza in the 0–4 yo population was very low and a complete hRSV eclipse occurred in 2011. Genetic analyses indicated that distinct evolutionary lineages of Flu A(H1N1)pdm2009, Flu A/H3N2 and Flu B have co-circulated in Bolivia in the study period, originating from Central and North America, Europe, Asia and Australia.ConclusionOur results emphasise the requirement for a reinforced epidemiological and genetic follow-up of influenza and other ILIs in Bolivia to further inform the preparation of vaccines used in the region, guide vaccination campaigns and improve the medical management of patients.
Highlights
Acute respiratory infections represent a serious public health issue worldwide but virological aetiologies of Influenza Like Illnesses (ILIs) remain largely unknown in developing countries
We did not attempt to build a representative sample of specimens received at CENETROP, but rather examined a similar number of samples in each age group to allow a comprehensive aetiological analysis in all age classes
It was not designed for providing a representative picture of the general Bolivian population: (i) samples originated from the region of Santa Cruz only; (ii) samples sent to CENETROP were not expected to faithfully represent ILIs in the region of Santa Cruz, with obvious recruitment biases such as clinical severity or access to public medical care; (iii) sampling was performed with the objective of obtaining equivalent numbers of cases in all age classes
Summary
Acute respiratory infections represent a serious public health issue worldwide but virological aetiologies of Influenza Like Illnesses (ILIs) remain largely unknown in developing countries. Deciphering the epidemiological and pathophysiological links between viral primary infection and secondary bacterial super-infection and pneumonia currently represents a major challenge for improving the prevention and medical management of pneumonia. Despite their importance in terms of morbidity as well as infant mortality, microbiological aetiologies of ARIs represent a complex, which has yet to be fully characterized in developed countries and remains largely unknown in developing countries. The viral aetiology of infections was investigated based on naso-pharyngeal swabs collected in a National Reference Laboratory in the city of Santa Cruz de la Sierra and real time PCR molecular biology techniques, viral cultures and phylogenetic analyses
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