Cases Of Pandemic Influenza Research Articles

Coinfections with SARS-CoV-2 variants and influenza virus during the 2019 Coronavirus disease pandemic in Burkina Faso: A surveillance study.

Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) particularly the variants of concern coinfections with influenza is a public health concern in Africa. We aimed to characterize the SARS-CoV-2 variants and determine the rate of coinfections with influenza in Burkina Faso. COVID-19 surveillance study was conducted between August 2021 and January 2022 using reverse transcription polymerase chain reaction(RT-PCR). Positive specimens were further screened for SARS-CoV-2 variants using the multiple variants real-time PCR kits. In addition, influenza virus strains were detected by RT-PCR in SARS-CoV-2 positive specimens using the CDC primers, probes, and protocols. Of 324 specimens assessed, the Omicron and Delta variants of SARS-CoV-2 were the most prevalent with 27.2% [95% confident interval (CI): 22.5-32.4] and 22.2% [95% CI: 17.9-27.2], respectively. The Beta and Gamma variants were detected in 4.3% [95% CI: 2.4-7.1] and 0.3% [95% CI: 0.0-1.7], respectively. Coinfections of Omicron and Beta variants were reported in 21.3% [95% CI: 17.0-26.2], Omicron and Delta variants in 1.2% [95% CI: 0.3-3.1] of specimens, and the Omicron-Gamma variants' coinfections in 0.6% [95% CI: 0.1-2.2]. One COVID-19 specimen with an undetected SARS-CoV-2 variant was also tested positive for the seasonal influenza A (H3N2) virus. No cases of pandemic influenza A (H1N1)pdm09, seasonal A/H1N1, and influenza B were detected. The current WorldHealth OrganizationSARS-CoV-2 variants of concern were prevalent and their coinfections with influenza were uncommon. Continuous surveillance of both pathogens is, however, needed because of their public health implications.

Widespread Prevalence of Antibodies Against Swine Influenza A (pdm H1N1 09) Virus in Pigs of Eastern Uttar Pradesh, India.

Swine influenza virus (SIV) belongs to family Orthomyxoviridae and can cause acute respiratory infection in pigs. Several pandemic H1N1 human fatal influenza cases were reported in India. Though pigs are predisposed to both avian and human influenza virus infections with the potential to generate novel reassortants, there are only a few reports of SIV in Indian pigs. We conducted a serological survey to assess the status of H1N1 infection in pigs of various states in India, between 2009 and 2016. Based on Haemagglutination inhibition (HI) assay, seroprevalence rate of H1N1 virus ranged between 5.2% (2009) and 36.3% (2011). Widespread prevalence of antibody was observed in eastern Uttar Pradesh from 6.2 to 37.5% during the study period. Co-circulation of seasonal H1N1 virus along with pandemic H1N1 virus was indicated by the presence of specific antibodies against seasonal H1N1 virus in eastern part of Uttar Pradesh. Seroprevalence rate in pigs and influenza infection trend in human shows the possible spill over transmission of influenza to pigs from human. Hence, besides serological surveillance, continuous and systematic molecular surveillance should be implemented in pig population to reduce/quantify the risk and emergence of pandemic influenza.

A series of COVID-19 autopsies with clinical and pathologic comparisons to both seasonal and pandemic influenza.

Autopsies of patients who have died from COVID‐19 have been crucial in delineating patterns of injury associated with SARS‐CoV‐2 infection. Despite their utility, comprehensive autopsy studies are somewhat lacking relative to the global burden of disease, and very few comprehensive studies contextualize the findings to other fatal viral infections. We developed a novel autopsy protocol in order to perform postmortem examinations on victims of COVID‐19 and herein describe detailed clinical information, gross findings, and histologic features observed in the first 16 complete COVID‐19 autopsies. We also critically evaluated the role of ancillary studies used to establish a diagnosis of COVID‐19 at autopsy, including immunohistochemistry (IHC), in situ hybridization (ISH), and electron microscopy (EM). IHC and ISH targeting SARS‐CoV‐2 were comparable in terms of the location and number of infected cells in lung tissue; however, nonspecific staining of bacteria was seen occasionally with IHC. EM was unrevealing in blindly sampled tissues. We then compared the clinical and histologic features present in this series to six archival cases of fatal seasonal influenza and six archival cases of pandemic influenza from the fourth wave of the ‘Spanish Flu’ in the winter of 1920. In addition to routine histology, the inflammatory infiltrates in the lungs of COVID‐19 and seasonal influenza victims were compared using quantitative IHC. Our results demonstrate that the clinical and histologic features of COVID‐19 are similar to those seen in fatal cases of influenza, and the two diseases tend to overlap histologically. There was no significant difference in the composition of the inflammatory infiltrate in COVID‐19 and influenza at sites of acute lung injury at the time of autopsy. Our study underscores the relatively nonspecific clinical features and pathologic changes shared between severe cases of COVID‐19 and influenza, while also providing important caveats to ancillary methods of viral detection.

Expression of Surfactant Protein D Distinguishes Severe Pandemic Influenza A(H1N1) from Coronavirus Disease 2019.

The differentiation between influenza and coronavirus disease 2019 (COVID-19) could constitute a diagnostic challenge during the ongoing winter owing to their clinical similitude. Thus, novel biomarkers are required to enable making this distinction. Here, we evaluated whether the surfactant protein D (SP-D), a collectin produced at the alveolar epithelium with known immune properties, was useful to differentiate pandemic influenza A(H1N1) from COVID-19 in critically ill patients. Our results revealed high serum SP-D levels in patients with severe pandemic influenza but not those with COVID-19. This finding was validated in a separate cohort of mechanically ventilated patients with COVID-19 who also showed low plasma SP-D levels. However, plasma SP-D levels did not distinguish seasonal influenza from COVID-19 in mild-to-moderate disease. Finally, we found that high serum SP-D levels were associated with death and renal failure among severe pandemic influenza cases. Thus, our studies have identified SP-D as a unique biomarker expressed during severe pandemic influenza but not COVID-19.

Number of cases of pandemic influenza in Brazil in 2009 and 2010

Pandemic Influenza is an extremely transmissible infectious disease. The main symptoms an individual may develop are: cough, sore throat, runny nose, fever and difficulty breathing. The objective of this work was to show the number of cases of pandemic influenza in Brazil in the years 2009 and 2010. Research carried out in the database of the Department of Informatics of the Unified Health System of Brazil – DATASUS (http://datasus.saude.gov.br/). The influenza virus has as characteristic its extreme transmissibility, a factor that contributed to the high number of infected. In 2010, a numerical reduction in cases was noted, probably due to the expansion of population knowledge about the prevention and knowledge of the disease and its organic implications. It was observed that, in 2009 and 2010, there were more cases of pandemic influenza among females (mostly in women of childbearing age, whether pregnant or not), in Brazil, and consequently higher number of deaths. When compared to 2009, in 2010 there were more cases in which the patient evolved positively, reaching the outcome of cure.

The dynamic effects of infectious disease outbreaks: The case of pandemic influenza and human coronavirus

Pandemic influenza is a regularly recurring form of infectious disease; this work analyses its economic effects. Like many other infectious diseases influenza pandemics are usually of short, sharp duration. Human coronavirus is a less regularly recurring infectious disease. The human coronavirus pandemic of 2019 (COVID-19) has presented with seemingly high transmissibility and led to extraordinary socioeconomic disruption due to severe preventative measures by governments. To understand and compare these events, epidemiological and economic models are linked to capture the transmission of a pandemic from regional populations to regional economies and then across regional economies. In contrast to past pandemics, COVID-19 is likely to be of longer duration and more severe in its economic effects given the greater uncertainty surrounding its nature. The analysis indicates how economies are likely to be affected due to the risk-modifying behaviour in the form of preventative measures taken in response to the latest novel pandemic virus.

Hemagglutinin as potential in vivo driver of DQ6-restricted clonal expansion of CD4+ T cells cross-reactive with hypocretin in narcolepsy

Abstract Narcolepsy is a sleeping disorder, caused by selective loss of neurons secreting a wake-promoting hormone, hypocretin (HCRT). Increased narcolepsy incidence was noted in China after the peak of 2009 H1N1 pandemic influenza (pH1N1) cases and in Europe after Pandemrix vaccine administration. The causes of HCRT neuron depletion and its relationship with pH1N1 are unknown. As narcolepsy susceptibility is associated with HLA-DQ6 and with a TCR α gene (J24) polymorphism, we hypothesized that abnormally expanded J24+/CD4+ T cells in DQ6+ subjects mediate autoimmunity against HCRT neurons and that molecular mimicry (epitopes in pH1N1 and self-antigens) drives T cell expansion via DQ6 presentation. We reported the in vivo expansion of DQ6/HCRT87–97–reactive J24+/CD4+ clones using a J24 allele and an un-conventional phenotype in patients compared to related clones in DQ6+ controls. Here, DQ6/peptide binding and crystal structure identify an epitope, HA274–287 from pH1N1 hemagglutinin, with homology to HCRT87–97 and another peptide, HCRT1–13. DQ6/HA274–287 tetramers isolated >2000 tetramer+/CD4+ T cells in DQ6+ subjects. Single-cell sequencing of TCRs and 25 phenotypic transcripts identify a DQ6/HA274–287 tetramer+/J24+ clone with the identical TCR clonotype (TCR27) and phenotype as the expanded DQ6/HCRT87–97–reactive J24+ clones previously found in the same patient. Control-derived TCR27+ clones identified by DQ6/HCRT1–13 or DQ6/HCRT25–37 tetramers are unexpanded and lack expression of any of the phenotypic genes. Our findings show that DQ6+ subjects carry J24+/CD4+ cells, both public and cross-reactive (e.g TCR27). TCR27 expansion in patients argues for molecular mimicry as a factor in narcolepsy immunopathogenesis.

Care for diabetes with COVID-19: Advice from China.

Care for diabetes with COVID-19: Advice from China.

Knowledge, attitude and practice study on swine flu (H1N1) among adolescent school children in Kolhapur district in Maharashtra

Background: Swine flu (H1N1) is very infectious respiratory disease occurring in different parts of world showing pandemicity from time to time. Thorough knowledge about its epidemiology and clinical symptoms, attitude towards disease and practices to prevent its occurrence and spread are essential in all age groups especially in school children. To assess the awareness, practices, their attitude and myths regarding swine flu among adolescent school going children in Kolhapur district Maharashtra.Methods: A pre-tested questionnaire was designed emphasized on the demographic profile, knowledge and misconceptions about cause, transmission, prevention and cure of swine flu (H1N1) and social responsibility of every student about spreading awareness. The questionnaires were distributed to school students of 9th& 10th standard only. Maximum 15 minutes were allotted to participants. A power point presentation regarding swine flu was delivered to participants and staff members.Results: Total 210 study participants were included. 80.47% students knew cause of swine flu is viral and 69.04% knew it spreads through airborne route. 73.33% students correctly knew about symptoms of swine flu. 71.90% mentioned all the correct preventive methods as wearing face mask of appropriate size, vaccination against swine flu and maintaining hand hygiene. In reality only 32.38% students exclusively practicing hand hygiene.Conclusions: Although the term was well known, better recognition of pandemic influenza cases is needed. Children were not aware about certain important treatment and prevention aspects of the disease.

Description of social contacts among student cases of pandemic influenza during the containment phase, Melbourne, Australia, 2009.

IntroductionStudents comprised the majority of early cases of influenza A(H1N1)pdm09 in Melbourne, Australia. Students and school settings were targeted for public health interventions following the emergence of pH1N1. This study was conducted to describe changes in social contacts among the earliest confirmed student cases of pH1N1 in Melbourne, Australia, to inform future pandemic control policy and explore transmission model assumptions.MethodsA retrospective cross-sectional behavioural study of student cases with laboratory-confirmed pH1N1 between 28 April and 3 June 2009 was conducted in 2009. Demographics, symptom onset dates and detailed information on regular and additional extracurricular activities were collected. Summary measures for activities were calculated, including median group size and median number of close contacts and attendance during the students’ exposure and infectious periods or during school closures. A multivariable model was used to assess associations between rates of participation in extracurricular activities and both school closures and students’ infectious periods.ResultsAmong 162 eligible cases, 99 students participated. Students reported social contact in both curricular and extra-curricular activities. Group size and total number of close contacts varied. While participation in activities decreased during the students’ infectious periods and during school closures, social contact was common during periods when isolation was advised and during school closures.DiscussionThis study demonstrates the potential central role of young people in pandemic disease transmission given the level of non-adherence to prevention and control measures. These finding have public health implications for both informing modelling estimates of future pandemics and targeting prevention and control strategies to young people.

Clinical Evaluation of Cases of Pandemic H1N1 Influenza in Sanliurfa Province in Epidemic Period

Amaç: Bu çalışmada; influenza benzeri hastalık tanımına uyan ve hastaneye yatırılan 75 olgu ile ilgili deneyimlerimizin paylaşılması amaçlandı.Hastalar ve Yöntem: PZR (polimeraz zincir reaksiyonu) yöntemiyle RNA (ribonükleik asit) tespit edilmiş pandemik 2009 influenza pozitif olgular ile negatif olguların yaş, cinsiyet ve altta yatan hastalık ilişkileri, laboratuvar ve radyolojik görüntüleme sonuçları, hastanede ve yoğun bakımda yatış süreleri ve taburculuk şekilleri karşılaştırıldı. Bulgular: Her iki grup arasında cinsiyet dağılımı, yaş ve akciğer grafisi bulguları açısından anlamlı bir fark görülmedi. Gruplar arası laboratuvar parametrelerinden CRP(C-reaktif protein) ve platelet düzeyleri karşılaştırıldığında arada anlamlı fark bulunurken beyaz küre, hemoglobin, nötrofil ve lenfosit sayıları açısından arada anlamlı fark bulunmadı. H1N1 pozitif grupta ortalama CRP miktarı H1N1 negatif gruba göre anlamlı olarak daha yüksek düzeyde bulundu. H1N1 pozitif grupta ortalama platelet miktarı anlamlı olarak H1N1 negatif gruba göre daha düşük bulundu. Sonuç: Pandemik H1N1 influenza olgularının klinik takipleri oldukça önemlidir. Altta yatan kronik hastalık zemininde pandemik influenzanın (H1N1) bazı vakalarda fatal seyredebileceği düşünüldü.

Influenza virus infections from 0 to 2 years of age: A birth cohort study.

Influenza vaccine has been recommended in Finland since 2007 for all children of 6-35 months of age and in 2009 for those ≥6 months against pandemic influenza. We investigated the incidence of influenza and vaccine effectiveness in a birth cohort of children in 2008-2011. We followed 923 children from birth to 2 years of age for respiratory tract infections. A nasal swab sample for PCR for influenza A and B viruses was taken at the onset of acute respiratory infections. Samples were collected either at the study clinic or at home by parents. Vaccination data was retrieved from the health registries. Vaccination coverage of children aged 6-23 months was 22-47% against seasonal influenza and 80% against the A(H1N1)pdm09 virus in the pandemic season 2009-2010. During 3 influenza seasons, 1607 nasal swab samples were collected. Influenza was confirmed in 56 (6.1%) of 923 children (16 A(H1N1), 14 A(H3N2), and 26B viruses). The incidence of influenza was 5.1% in 2008-2009, 2.7% in 2009-2010, and 5.0% in 2010-2011. Effectiveness of the adjuvanted vaccine against the pandemic influenza A(H1N1)pdm09 was 97% (95% confidence interval, 76-100%). Three children with influenza were hospitalized. The yearly incidence of seasonal influenza was 5% in this cohort of very young children with variable influenza vaccine coverage. Adjuvanted vaccine against the pandemic influenza was highly effective. Both seasonal and pandemic influenza cases were mostly non-severe.

IFITM3, TLR3, and CD55 Gene SNPs and Cumulative Genetic Risks for Severe Outcomes in Chinese Patients With H7N9/H1N1pdm09 Influenza.

We examined associations between single-nucleotide polymorphisms (SNPs) of IFITM3, TLR3, and CD55 genes and influenza clinical outcomes in Chinese. A multicenter study was conducted on 275 adult cases of avian (H7N9) and pandemic (H1N1pdm09) influenza. Host DNA was extracted from diagnostic respiratory samples; IFITM3 rs12252, TLR3 rs5743313, CD55 rs2564978, and TLR4 rs4986790/4986791 were targeted for genotyping (Sanger sequencing). The primary outcome analyzed was death. IFITM3 and TLR3 SNPs were in Hardy-Weinberg equilibrium; their allele frequencies (IFITM3/C-allele 0.56, TLR3/C-allele 0.88) were comparable to 1000 Genomes Han Chinese data. We found over-representation of homozygous IFITM3 CC (54.5% vs 33.2%; P = .02) and TLR3 CC (93.3% vs 76.9%; P = .04) genotypes among fatal cases. Recessive genetic models showed their significant independent associations with higher death risks (adjusted hazard ratio [aHR] 2.78, 95% confidence interval [CI] 1.29-6.02, and aHR 4.85, 95% CI 1.11-21.06, respectively). Cumulative effects were found (aHR 3.53, 95% CI 1.64-7.59 per risk genotype; aHR 9.99, 95% CI 1.27-78.59 with both). Results were consistent for each influenza subtype and other severity indicators. The CD55 TT genotype was linked to severity. TLR4 was nonpolymorphic. Host genetic factors may influence clinical outcomes of avian and pandemic influenza infections. Such findings have important implications on disease burden and patient care in at-risk populations.

Surveillance of Influenza A/California/H1N1 in Dnipropetrovsk, Ukraine

IntroductionUkraine’s ability to respond to the spread of viruses that causepandemics and reduce economic losses from influenza, can bestrengthened only in the presence of a developed surveillance networkincluding the monitoring of virus circulation in humans. Specialistsof Dnipropetrovsk Oblast have great experience in virologicalsurveillance on the circulation of influenza virus A/California/H1N1and timely determination of the etiology of outbreaks caused by thevirus.MethodsLaboratory diagnostics of influenza was performed usingserological methods, PCR, and virological studies in the cell culture.During the last seven epidemic seasons, including the flu pandemicof 2009-2010, most of samples came from four health-care facilitiesof Dnipropetrovsk, which were determined as basic hospitals forthe sentinel center. Patients with severe acute respiratory infections(SARI) were examined. Nasopharyngeal washouts and swabs werecollected into cryo-tubes with a transport medium. The samples werestored at hospitals in Dewar flasks.The delivery of the samples to the laboratory was performedaccording to cold-chain rules. After sample preparation stage, thesamples were tested for the presence of influenza A/B virus RNA byPCR using Bio-Rad CFX-96 cycler and the following commercialtest-kits AmpliSens® Influenza virus A/B-FL, AmpliSens® Influenzavirus A/H1-swine, and AmpliSens® Influenza virus A-type-FL.All positive samples with detected RNA of influenza virusA/H1-swine were tested using MDSK cell cultures (Canine KidneyEpithelial Cells). Flu viruses caused cytopathic changes in the cellcultures in the form of poppy-sand-like degeneracy not earlier thanin 72 hours after the infection of the cells followed by cell monolayerfragmentation.Fig. 1 MDSK cell cultureFig. 2 MDSK cell culture 72 hours after infection with influenzavirus A (H1N1)Express immunochromatic tests «Cito test influenza A+B» oragglutination test (AT) using erythrocyte suspension of human 0 (I)group blood were used for the determination of haemagglutinatingagents.ResultsDuring the seven epidemic seasons, 5,467 people were examinedfor flu and acute respiratory viral infections. During the swine flupandemic in 2009-2010, 1,217 severely ill patients were tested.Positive results were found in 50% of cases (607 persons). Fromthose, pandemic influenza virus (RNA of influenza A/H1-swinevirus) was detected in 100% of positive cases.Fig.3 Data on the determined pandemic flu virus strains(RNA of influenza A/H1-swine virus) using PCR duringepidemiological seasons from 2009 to 2016 in DnipropetrovskOblast, UkraineFrequency of pandemic influenza virus detection declined to zeroin the following epidemic seasons (2010-2011 and 2011-2012).However, incidence of the virus variant (influenza A/H1-swine)began to grow slowly during the last four epidemic flu seasonsfrom separate cases (6 in 2012-2013, 1 in 2012-2013) to 26 cases in2014-2015. During the last epidemic season (2015-2016), the numberof pandemic influenza cases increased dramatically to 166, accounting29% of all examined persons.Fig. 4 Results of isolation of pandemic strains of influenzaviruses in cell culture MDSK flu epidemic seasons from 2009-2010to 2015-2016 in Dnipropetrovsk Oblast, UkraineMost of the virus isolates were sent for confirmation and furtheridentification to the Ukrainian Center for Influenza and to theworld influenza centers (Atlanta, USA and London, UK) in order tosupport Ukraine’s participation in the worldwide pandemic influenzasurveillance. The world flu centers confirmed the isolates to beinfluenza virus strain A/California/(H1N1)/07/2009.Conclusions1. Circulation of the pandemic type of influenza virus A/California/(H1N1)/ 07/2009 among the population of Dnipropetrovsk oblast isof sporadic character.2. The return of the virus A/California/(H1N1)/07/2009 after the2009-2010 pandemic occurred during the last 2015-2016 epidemicseason.3. Application of PCR can significantly shorten the examination ofpatients with severe course of influenza, but cannot help with virusisolation.4. The use of express immunoassay tests accelerates theidentification of viruses isolates.5. The employment MDSK cell culture for influenza virusisolation allows obtaining of a spectrum of influenza strainscirculating during an epidemic period including the strainA/California/(H1N1)/07/2009.

The 2009 H1N1 Pandemic Influenza in Korea.

In late March of 2009, an outbreak of influenza in Mexico, was eventually identified as H1N1 influenza A. In June 2009, the World Health Organization raised a pandemic alert to the highest level. More than 214 countries have reported confirmed cases of pandemic H1N1 influenza A. In Korea, the first case of pandemic influenza A/H1N1 infection was reported on May 2, 2009. Between May 2009 and August 2010, 750,000 cases of pandemic influenza A/H1N1 were confirmed by laboratory test. The H1N1-related death toll was estimated to reach 252 individuals. Almost one billion cases of influenza occurs globally every year, resulting in 300,000 to 500,000 deaths. Influenza vaccination induces virus-neutralizing antibodies, mainly against hemagglutinin, which provide protection from invading virus. New quadrivalent inactivated influenza vaccine generates similar immune responses against the three influenza strains contained in two types of trivalent vaccines and superior responses against the additional B strain.

Epidemiological & clinical profile of influenza A (H1N1) 2009 virus infections during 2015 epidemic in Rajasthan.

Background & objectives:Pandemic influenza A (H1N1) 2009 virus emerged in 2009 and caused pandemic with high morbidity and mortality in India and worldwide. The number of H1N1-positive cases varied in different years in Rajasthan. The objective of the study was to present the epidemiological profile of pandemic influenza A (H1N1) 2009 virus cases in Rajasthan from January to March 2015.Methods:A retrospective descriptive, record-based analysis of suspected and confirmed cases of pandemic influenza A (H1N1) 2009 virus infection in Rajasthan, India, from January to March 2015 was performed. Testing was done as per the Centers for Disease Control guidelines at nine laboratories approved by the Government of Rajasthan. Data were analyzed in terms of demographic characteristics, clinical presentation and outcome.Results:Among 18,187 tested cases, 6203 (34.10%) were positive. Death occurred in 378 cases, with six per cent case fatality rate. Maximum number of cases (n=2801) and deaths (n=101) were from Jaipur zone. The highest number of cases, 47.60 per cent (2953/6203) and deaths, 52.11 per cent (197/378) were in the age group of 26-50 yr; 52.64 per cent (199/378) of deaths occurred in females. The highest number (63.5%) of deaths was from urban areas. Associated risk factors were observed in 59.44 per cent of the death cases, pregnancy being the predominant predisposing factor. In 61.92 per cent of patients, death occurred within three days of hospitalization.Interpretation & conclusions:H1N1 epidemic caused high morbidity and mortality in early 2015, particularly in the younger and middle-aged population and pregnant women in Rajasthan State of India. The study highlights the regular surveillance of influenza like illness, early diagnosis and timely initiation of therapy in suspected cases.

The "wicked problems" of governing UK health security disaster prevention: The case of pandemic influenza.

PurposeThe purpose of this paper is to examine the governance and policy-making challenges in the context of “wicked problems” based on the case of pandemic influenza. Design/methodology/approachThe case study research is based on an analysis of official documentation and interviews with policy elites at multiple levels of UK governance. FindingsResults of this study show that policy actors regard risk communication, the dynamics of international public policy and UK territorial governance as the main governance challenges in the management of influenza at a macro-level. The paper also serves to identify that although contingencies management for epidemiological issues require technical and scientific considerations to feature in governance arrangements, equally there are key “wicked problems” in the context public policy that pervade the health security sector. Practical implicationsThe study indicates the need to build in resources at a national level to plan for policy coordination challenges in areas that might at first be seen as devoid of political machinations (such as technical areas of public policy that might be underpinned by epidemiological processes). The identification of the major governance challenges that emerge from the pandemic influenza case study is a springboard for a research agenda in relation to the analysis of the parallels and paradoxes of governance challenges for health security across EU member states. Originality/valueThis paper provides a novel interrogation of the pandemic influenza case study in the context of UK governance and public policy by providing a strategic policy lens from perspective of elites.

Cultural epidemiology of pandemic influenza in urban and rural Pune, India: a cross-sectional, mixed-methods study

ObjectiveTo identify and compare sociocultural features of pandemic influenza with reference to illness-related experience, meaning and behaviour in urban and rural areas of India.DesignCross-sectional, mixed-methods, cultural epidemiological survey with vignette-based...

Brain magnetic resonance imaging in acute phase of pandemic influenza A (H1N1) 2009--associated encephalopathy in children.

Pandemic influenza A (H1N1) 2009 has been shown to be associated more with neurological complications than the seasonal influenza virus. In this study, we focused on the clinical usefulness of magnetic resonance imaging (MRI) in the acute phase of influenza A (H1N1) 2009-associated encephalopathy. A questionnaire was distributed to pediatric and general hospitals in Japan that treat children with encephalopathy. We conducted a questionnaire-based study involving the collection of information regarding 207 patients with encephalopathy. Brain MRI was performed in 97 of these 207 patients in the age group of 9 months to 15 years (mean, 7.5 years) within 48 hours after the development of encephalopathy symptoms. Sixty-six patients (68%) showed normal imaging. Diffuse brain edema was visible in five patients and an abnormal signal in the deep gray matter in two patients which is consistent with acute necrotizing encephalopathy. Abnormal signals of the splenial lesion, subcortical white matter (bright tree appearance), and cortical area were observed in 15, 1, and 8 patients, respectively. From our findings based on the questionnaire results, we suggest that MRI is useful for determining fatal cases of pandemic influenza A (H1N1) 2009 infection when performed in the acute phase. However, MRI is not useful in predicting the development of sequelae.

Clinical Characteristics and Cost Burden of Children Hospitalized with Pandemic Influenza A (H1N1-2009) in a Tertiary Care Center in İstanbul.

Dear Editor, After the detection of the first case in April 2009, pandemic H1N1 influenza caused infection in more than 214 countries, resulting in at least 18,449 deaths. A multicenter study in Turkey revealed that 821 children were hospitalized with pandemic H1N1 influenza (1). The economic burden of pandemic H1N1 influenza has been estimated for many countries (2–4). We aimed to evaluate the clinical features and direct medical costs of children hospitalized with pandemic H1N1 influenza in comparison with H1N1 negative patients. Charts of children admitted to a single center with suspicion of pandemic H1N1 influenza were reviewed. Patients with clinical findings compatible with the criteria defined by the World Health Organization or a history of contact with a person with influenza-like illness (ILI) who had undergone microbiologic testing were included. The “in-house” real-time polymerase chain reaction protocol provided by the Centers for Disease Control and Prevention was used for the detection of pandemic H1N1 influenza. Underlying risk factors, clinical features, and total costs were determined. Total costs included bed stay, diagnostics, pharmacy, and charges for medical services. The present retrospective study was approved by the Institutional Ethics Committee and written informed consent was taken from all parents or legal guardians. Among 90 patients hospitalized during November 2009 and January 2010, 32 were laboratory confirmed cases of pandemic H1N1 influenza. 43.8% had an underlying risk factor, with neuromuscular disorders (18.8%) and chronic respiratory diseases (15.5%) being the most common. 31.2% had thrombocytopenia (platelets 11×103/mL), 37% had elevated aspartate amino-transferase (>35 IU/L) and 18% had elevated alanine aminotransferase levels (>46 IU/L). Fever (100% versus 84%) and lethargy (28.1% versus 8.6%) were more prevalent in H1N1 positive patients in comparison to H1N1 negative cases. Only one patient with pandemic H1N1 influenza and neuromuscular disease died on the 11th day of admission. The median cost of hospitalization for pandemic H1N1 influenza was $254 USD per case (Table 1). TABLE 1 Demographic, clinical and cost data of H1N1 positive and H1N1 negative patients Our study provides the first evidence that pandemic H1N1 influenza resulted in a substantial cost burden related to hospitalized children in Turkey. In comparison with H1N1 negative patients, the direct cost was slightly higher in the H1N1 positive group, but the difference was not significant since the majority of patients had received antiviral and antibiotic treatment due to heightened concern of physicians. The clinical features of the two groups were similar, except for a higher prevalence of fever and lethargy in the H1N1 positive patients. A similar study conducted in an adult population of Turkey revealed that altered mental status, fever ≥38°C, and tachypnea were significantly higher in patients with confirmed influenza (5). The mean hospital charges incurred for the 61 hospitalized children during the spring 2009 pandemic influenza epidemic in Wisconsin was $14,687 USD (2). Total direct health care costs were determined to be $510 USD per patient hospitalized with pandemic H1N1 influenza in Malaysia (3). Zarogoulidis et al. (4) reported that health care costs were higher for pandemic H1N1 influenza compared with non-H1N1 respiratory infections, mainly due to the protection measures used and the increased duration of hospitalization in the intensive care unit.