High Influenza Incidence Research Articles

Synthesis of Rupestonic Acid L-Ephedrine Derivatives with Preliminary In vitro Anti-influenza Viral Activity.

Influenza virus is a kind of RNA virus. Nowadays, the high incidence of influenza and the morbidity and mortality of epidemic influenza are substantial. It has been reported that one hundred million people in the world are infected with influenza viruses, and two hundred and fifty thousand to five hundred thousand people die from the flu per year. In 2021, the number of infected persons in China was reported to be 654,700, and 0.07% of the infected persons died. The flu has caused a serious threat to human survival. Although several drugs, such as Zanamivir, Oseltamivir, Peramivir, and Laninamivir, have been used in clinics for the treatment of the influenza virus, there are some shortcomings of these drugs. The strain of influenza H5N1 (avian influenza) has been found to resist the effective drug Oseltamivir. Thus, there is an urgent demand to discover new influenza virus inhibitors to overcome the emergence of influenza antigens. This study aimed to develop new influenza virus inhibitors based on the rupestonic acid parent core. The rupestonic acid L-ephedrine ester (A) and rupestonic acid L-ephedrine complex (B) were synthesized in this work for the development of influenza virus inhibitors. The target compounds were synthesized using rupestonic acid and L-ephedrine as starting materials. Their structures were characterized by 1H NMR and 13C NMR, and the purity was determined by HPLC. Then, their preliminary in vitro influenza activity was evaluated using Oseltamivir as a reference drug. The results showed that the synthesized rupestonic acid L-ephedrine derivatives A and B were more potent influenza virus inhibitors against the strains of A/PR/8/34 (H1N1) and A/FM/1/47 (H1N1) with the IC50 values of 51.0, 51.0 μM and 441.0, 441.0 μM, respectively, than that of rupestonic acid. By comparing the IC50 of compounds A and B, compound A can be regarded as a very promising lead compound for the development of influenza virus inhibitors. The rupestonic acid L-ephedrine ester (A) and rupestonic acid L-ephedrine complex (B) were synthesized and characterized using 1H NMR and 13C NMR. Moreover, their purity was determined by HPLC. Both compounds A and B exhibited more potent activities against the strains of A/PR/8/34 (H1N1) and A/FM/1/47 (H1N1) than rupestonic acid. Compound A can be regarded as a very promising lead compound for the development of influenza virus inhibitors. Based on these results, more rupestonic acid derivatives will be designed and synthesized in the future for the development of influenza virus inhibitors.

High Influenza Incidence and Disease Severity Among Children and Adolescents Aged

During the 2022-23 influenza season, early increases in influenza activity, co-circulation of influenza with other respiratory viruses, and high influenza-associated hospitalization rates, particularly among children and adolescents, were observed. This report describes the 2022-23 influenza season among children and adolescents aged <18 years, including the seasonal severity assessment; estimates of U.S. influenza-associated medical visits, hospitalizations, and deaths; and characteristics of influenza-associated hospitalizations. The 2022-23 influenza season had high severity among children and adolescents compared with thresholds based on previous seasons' influenza-associated outpatient visits, hospitalization rates, and deaths. Nationally, the incidences of influenza-associated outpatient visits and hospitalization for the 2022-23 season were similar for children aged <5 years and higher for children and adolescents aged 5-17 years compared with previous seasons. Peak influenza-associated outpatient and hospitalization activity occurred in late November and early December. Among children and adolescents hospitalized with influenza during the 2022-23 season in hospitals participating in the Influenza Hospitalization Surveillance Network, a lower proportion were vaccinated (18.3%) compared with previous seasons (35.8%-41.8%). Early influenza circulation, before many children and adolescents had been vaccinated, might have contributed to the high hospitalization rates during the 2022-23 season. Among symptomatic hospitalized patients, receipt of influenza antiviral treatment (64.9%) was lower than during pre-COVID-19 pandemic seasons (80.8%-87.1%). CDC recommends that all persons aged ≥6 months without contraindications should receive the annual influenza vaccine, ideally by the end of October.

АНАЛИЗ ЗАБОЛЕВАЕМОСТИ ГРИППА, ОРВИ И КОРОНА-ВИРУСНОЙ ИНФЕКЦИИ В КЫРГЫЗСКОЙ РЕСПУБЛИКЕ

Acute respiratory viral infections in the Kyrgyz Republic occupy a high proportion among the overall structure of infectious morbidity, over 61.0%. The purpose of this work is to study the epidemiological features of influenza, SARS and coronavirus infections in different climatogeographic regions of the Kyrgyz Republic. The materials were the reporting data of the republican headquarters for the fight against coronavirus infection, DDPSSES and E-health center. The incidence of influenza and SARS have a pronounced seasonality. During the analyzed period from 2014 to 2022 in the republic, it was noted that the highest incidence of influenza and SARS is recorded in the period from November to February and the indicators vary from 371.2 to 702.1 per 100 000 population. In the dynamics of morbidity during a pandemic of coronavirus infection, the traditional seasonality, as with influenza and SARS, is not traced. The incidence of influenza, SARS and coronavirus infection in different climatogeographic regions have differences, which is associated with population density, average annual atmospheric air temperature and the level of migration of the population. The dynamics of the coronavirus pandemic has shown that the rise in incidence is associated with the level of population immunity and compliance with preventive measures.

Impact of Preventive Measures Against Covid-19 on the Prevalence of Infectious Diseases Among the Population of The Republic of Kazakhstan

Aim: To study the impact of COVID-19 preventive measures on airborne and fecal-oral infectious diseases in Kazakhstan Materials and Research Methods: We used comparative data from the Study of Sanitary and Epidemiological Control of Infectious Morbidity in the Population of the Kazakhstan for 2019-2020. In this case, there are infectious diseases transmitted mainly by airborne droplets among the entire population (children, adolescents and adults) and diseases with fecal-oral transmission. Results: The total number of cases detected was 1,239,635. Thus, the percentage change in the total number of cases from 2019 to 2020 was - (+) 5.6%. In 2019, 596,216 cases of infectious diseases transmitted by airborne droplets were detected, and in 2020 - 631,407, i.e. 35,191 more were revealed (+5.9%). ARVI and influenza account for the largest proportion in this group, and the incidence has increased in these groups. At the same time, exacerbations of diseases transmitted by the fecal-oral route: from 2019 to 2020, diseases occurred in 1,716 (-38.8%) cases. Conclusion: This study demonstrated a useful effective COVID-19 prevention measure for several other infectious diseases in Kazakhstan during the pandemic. However, special attention should be paid to the increase in the incidence of ARVI and influenza in Kazakhstan. Possible exceptions, according to the authors, are ignoring the high incidence of influenza and ARVI in 2020 compared to 2019, since special attention was focused on COVID-19. The next hypothesis is the impact of COVID-19 on influenza immunization in the country - restrictive measures have reduced the number of influenza vaccinated.

Influenza and Influenza-Like Virus Infection in Children Under 14 Years of Age: An Investigation of 725 Cases in the 2021/2022 Influenza Epidemic Season in Poland.

BACKGROUND Influenza in children poses a significant health problem worldwide. In this study we investigated 725 cases of influenza and influenza-like virus infection in children under 14 years of age in the 2021/2022 influenza epidemic season in Poland. MATERIAL AND METHODS The material for the study (nose and throat swabs) was collected during the 2021/2022 epidemic season. We analyzed 725 samples from the National Influenza Center, Department of Influenza Research at the National Institute of Public Health NIH-NRI or at 16 Voivodship Sanitary Epidemiological Stations across Poland. Quantitative polymerase chain reaction (qRT-PCR) was applied to determine the influenza virus type and subtype (in RNA isolated from positive samples). RESULTS This study shows the high incidence of influenza among children under the age of 14. Most confirmed infections were caused by influenza A. The genetic material of the A/H1N1/pdm09 subtype was not found among the analyzed samples. The highest number of influenza A infections was among the youngest children (the 0-4 years age group). The most common influenza-like virus was respiratory syncytial virus (RSV). The greatest number of cases caused by this respiratory virus was registered among the youngest children (0-4 years). CONCLUSIONS This study, which shows the high incidence of influenza among children under the age of 14, highlights the importance of regular influenza vaccination. Since children often play a dominant role in spreading influenza virus in the community, regular vaccination can have both health and economic benefits for all age groups.

Burden of influenza in Spanish pediatric population and the benefit of vaccination

IntroductionThe burden of influenza in the paediatric population is often underestimated by healthcare professionals and the general population, mainly due to poor perception of its clinical importance at the individual level and its health impact at the healthcare level. The aim of this review was to collect data on the burden of paediatric influenza in Spain and to compare them with data of countries where vaccination strategies for healthy paediatric populations have been implemented. MethodsWe collected data on the burden of paediatric influenza in Spain through a systematic search of literature published between 2016–2021 (PRISMA methodology). We conducted a review of reports from the Spanish Influenza Surveillance System (SVGE) (2010–2011 to 2019–2020) and of international reports (from Canada, Finland, USA, and UK) through a systematic (2016–2021) and pragmatic search. Results1366 articles were obtained from the systematic searches by country; 26 met the inclusion criteria. According to the SVGE (Spain's Influenza Surveillance System), those <15 years have the highest incidence of influenza per 100,000 population (cumulative-mean rate: 9457.9) compared to those ≥15 years (2285.6), and percentage of admission to the Paediatric Intensive Care Unit (PICU) greater than those >65 years (mean: 29.1% vs. 17.5%). Hospitalisation of severe cases per 100,000 population in children aged 0–4 years and those >65 years is similar (median: 20.2 vs. 28.4). Those aged <15 years have a higher incidence rate per 100,000 population (213.3), in contrast to those aged 15–64 years (21.9) and those aged ≥65 years (65.2). In countries with paediatric vaccination programmes (USA, Finland, and UK) the burden of influenza in children is reduced by 40%–74%, whereas 50%-93.5-% of cases presenting to the ED, hospitalised, admitted to PICU, or dying from influenza are unvaccinated. ConclusionsThe burden of paediatric influenza in Spain includes a significant number of hospitalisations and PICU admissions and justifies the vaccination strategy recommended by the WHO since 2012. In countries with this recommendation, the vaccinated paediatric population is better protected against severe forms of influenza and potential benefits for reducing the burden of paediatric influenza in Spain can be extracted from their data.

Influenza in Liver and Kidney Transplant Recipients: Incidence and Outcomes.

Influenza is a common respiratory tract infection in solid organ transplant (SOT) recipients. We aimed to investigate the incidence, risk factors, and complications of influenza in a large cohort of kidney and liver transplant recipients over 10 consecutive seasons. We conducted a retrospective study, including 378 liver and 683 kidney transplant recipients who were transplanted from January 1, 2010, to October 1, 2019. The data on influenza were retrieved from MiBa, which is a nationwide database that contains all of the microbiology results in Denmark. Clinical data were retrieved from patient records. Incidence rates and cumulative incidences were calculated, and risk factors were investigated using time-updated Cox proportional hazards models. The cumulative incidence of influenza in the first 5 years posttransplantation was 6.3% (95% CI: 4.7 to 7.9%). Of the 84 influenza positive recipients, 63.1% had influenza A, 65.5% were treated with oseltamivir, 65.5% were hospitalized, and 16.7% developed pneumonia. There were no significant differences in outcomes when comparing patients with influenza A and B. We found no significant effect of same-season influenza vaccination, sex, age, or comorbidities on the risk of acquiring influenza. The incidence of influenza in kidney and liver recipients is high, and 65.5% of infected transplant recipients required hospitalization. We were not able to confirm a reduction in influenza incidence or in the risk of complications associated with vaccination. IMPORTANCE Influenza is a common respiratory virus in solid organ transplant recipients that may have severe complications, including pneumonia and hospitalization. This study investigates the incidence, risk factors, and complications of influenza in a Danish cohort of kidney and liver transplant recipients over 10 consecutive influenza seasons. The study shows a high incidence of influenza and a high frequency of both pneumonia and hospitalization. This emphasizes the importance of continuous focus on influenza in this vulnerable group. During the COVID-19 pandemic, the incidence of influenza has been low due to COVID-related restrictions, and immunity may have waned. However, as most countries have now opened up, the incidence of influenza is expected to be high this season.

Carga de gripe en la población pediátrica en España y los beneficios de la vacunación

IntroductionThe burden of influenza in the paediatric population is often underestimated by healthcare professionals and the general population, mainly due to poor perception of its clinical importance at the individual level and its health impact at the healthcare level. The aim of this review was to collect data on the burden of paediatric influenza in Spain and to compare them with data of countries where vaccination strategies for healthy paediatric populations have been implemented. MethodsWe collected data on the burden of paediatric influenza in Spain through a systematic search of literature published between 2016 and 2021 (PRISMA methodology).We conducted a review of reports from the Spanish Influenza Surveillance System (SVGE) (2010-2011 to 2019-2020) and of international reports (from Canada, Finland, USA, and UK) through a systematic (2016-2021) and pragmatic search. Results1,366 articles were obtained from the systematic searches by country; 26 met the inclusion criteria. According to the SVGE (Spain’s Influenza Surveillance System), those < 15 years have the highest incidence of influenza per 100000 population (cumulative-mean rate: 9,457.9) compared to those ≥ 15 years (2,285.6), and percentage of admission to the Paediatric Intensive Care Unit (PICU) greater than those > 65 years (mean: 29.1% vs. 17.5%). Hospitalisation of severe cases per 100,000 population in children aged 0-4 years and those > 65 years is similar (median: 20.2 vs. 28.4). Those aged < 15 years have a higher incidence rate per 100,000 population (213.3), in contrast to those aged 15-64 years (21.9) and those aged ≥ 65 years (65.2). In countries with paediatric vaccination programmes (USA, Finland, and UK) the burden of influenza in children is reduced by 40%-74%, whereas 50%-93.5-% of cases presenting to the ED, hospitalised, admitted to PICU, or dying from influenza are unvaccinated. ConclusionsThe burden of paediatric influenza in Spain includes a significant number of hospitalisations and PICU admissions and justifies the vaccination strategy recommended by the WHO since 2012. In countries with this recommendation, the vaccinated paediatric population is better protected against severe forms of influenza and potential benefits for reducing the burden of paediatric influenza in Spain can be extracted from their data.

An integrated dual-layer microfluidic platform for multiple respiratory viruses screening

Currently, the coronavirus disease 2019 (COVID-19) caused by the outbreak of a novel coronavirus (SARS-CoV-2) is spreading rapidly worldwide. Due to the high incidence of influenza coinciding with SARS-CoV-2, rapid detection is crucial to prevent spreading. Here, we present an integrated dual-layer microfluidic platform for specific and highly sensitive SARS-CoV-2, influenza viruses A (FluA) H1N1, H3N2, and influenza virus B (FluB) simultaneous detection. The platform includes a dual microchip (Dμchip) and a portable detection device for real-time fluorescence detection, temperature control and online communication. The Reverse Transcription Loop-mediated Isothermal Amplification (RT-LAMP) and Cas12a cleavage were performed on the Dμchip. The limit of detection (LoD) of the Dμchip assay was 10 copies for SARS-CoV-2, FluA H1N1, H3N2, and FluB RNAs. The Dμchip assay yielded no cross-reactivity against other coronaviruses, so it was suitable for the screening of multiple viruses. Moreover, the positive percentage agreement (PPA) and negative percentage agreement (NPA) of the assay were 97.9% and 100%, respectively, in 75 clinical samples compared to data from RT-PCR-based assays. Furthermore, the assay allowed the detection SARS-CoV-2 and influenza viruses in spiked samples. Overall, the present platform would provide a rapid method for the screening of multiple viruses in hospital emergency, community and primary care settings and facilitate the remote diagnosis and outbreak control of the COVID-19.

Population immunity in residents of the Kaliningrad region to current antigenic variants of influenza viruses over 2018-2021

The article presents the results of population immunity assessment in residents of the Kaliningrad region to current antigenic variants of influenza viruses over the period of 2018 to 2021. To assess spectrum of influenza types circulating in Kaliningrad region, the real-time PCR method was used using AmpliSense reagent kits. The biological material for the study was obtained from oropharyngeal swabs from the persons who applied to polyclinics with inflammatory diseases of upper respiratory tract, or underwent treatment at the out- or inpatient basis in a healthcare facilities of Kaliningrad region. Humoral immunity was assessed by testing blood sera obtained from healthy residents of Kaliningrad region during periodic prophylactic examinations at the city and regional polyclinics. The study of residents covered all age groups. For the period of 2018-2021, more than 14,000 studies have been carried out. Determination of specific serum antibody titers was carried out by staging the hemagglutination suppression reaction using local influenza antigens (LLC PPDP, St. Petersburg). Antibody titers of 1/40 and higher were considered sufficient to reduce the risk of disease by 50%. During the study period, 2165 cases of influenza were confirmed in the region by laboratory tests. Over the study period, the A(H1N1) pdm serotype proved to be the major strain causing influenza, its proportion reached 57.5%. However, along with A(H1N1) pdm, a significant contribution was also made the A(H3N2) strain to the epidemic process, being the etiological cause of influenza infection in 2019 (42.2%), type B influenza strains being actual in 2020 (42.5%). Over the period of 2018-2021, 420 samples of blood sera from vaccinated and non-vaccinated individuals were tested for specific antibodies. The sera were taken 1-2 months after vaccination and between epidemic rises of influenza (April-May). In vaccinated individuals, the antibody titer was protective in 58.3-64.5%. In this group of persons, the titer sufficient to produce immunity was maintained over the spring/summer period. Among those persons who refused vaccination, a protective antibody titer in the pre-epidemic period was noted in 41.2% of the examined, and during the off-season it was detected in 37.4% of the volunteers. Thus, the A(H1N1) pdm strain was the main etiological factor of influenza in Kaliningrad Region in 2018-2021. The protective level of antibodies in vaccinated population over the period preceding the epidemic peak, was observed 30% more often than in unvaccinated individuals. High incidence of influenza B strains noted in 2020 appears to require a change of specific vaccine preparation.

Utilizing Baidu Index to Track Online Interest in Influenza During the COVID-19 Pandemic in China.

BackgroundInfluenza is commonly called the flu which is a contagious respiratory illness caused by influenza viruses that infect the nose, throat, and sometimes the lungs, usually a self-limiting, febrile disease of global importance. It occurs every year and infects the respiratory tract and can lead to sporadic, local outbreaks of widespread epidemics. The global burden of influenza epidemics on incidence rate and mortality is considerable. It is noted that patients with early coronavirus disease-2019 (COVID-19) have symptoms such as headache, nasal congestion, sneezing, and cough, which are like those of influenza. And the outbreak of COVID-19 coincided with the winter and spring season in the northern hemisphere with a high incidence of influenza. And it leads to the public's attention to influenza.MethodIn order to better clarify the social concern of Chinese people about "influenza" during the COVID-19 pandemic, this study conducted a trends analysis using the Baidu index from January 1, 2018, to January 1, 2022, and compared the public's search index with "COVID-19" during this period. This study used ArcGIS version 10.4 (https://www.esri.com/) to conduct a Global Moran's I analysis of the public concern of "influenza" in 31 provinces (municipalities directly under the central government and autonomous regions) in China from 2018 to 2021, except for Hong Kong, Macao, and Taiwan and a Local Moran's I of the "influenza" concern in 2018 and 2021.ResultsWe observed that before the outbreak of COVID-19, the search trend of the public for "influenza" was concentrated in the winter and spring of each year, showing seasonal characteristics. However, after the outbreak of COVID-19, the public's search trend for "influenza" increased sharply, and then it leveled off. This shows completely that there is a certain correlation between the COVID-19 outbreak and the online search for "influenza". Regarding the Global Moran's I, the spatial clustering of national "influenza" concerns was observed.During the COVID-19 pandemic, the spatial correlation between the magnitude of public concern and the spatial correlation became larger as the number of years increased and is greater than that before the outbreak of the COVID-19 pandemic. The results of Local Moran's I showed that the main types of local spatial autocorrelation in 2018 and 2021 were both positive high-high correlations, but the former was mainly concentrated in the eastern coastal region, while the latter began to spread to the central region.ConclusionThe analysis of the Baidu Index shows that during the COVID-19 pandemic, the public's interest in "influenza" first increased and then decreased, and then remained at a trough, no longer showing the seasonal change characteristics before the outbreak of the COVID-19, indicating that there may be a correlation between COVID-19 and "influenza". The Moran's I indicate that the national "influenza" concern is spatially clustered, while the spatial correlation is increasing and greater than before the outbreak of the COVID-19 pandemic. This is most likely related to the daily update of information related to patients with COVID-19. Meanwhile, the "high-high" local clustering of "influenza" concerns in the central and eastern regions during the COVID-19 pandemic is related to the frequent human and logistic exchanges in the central and eastern regions, which contributed to the spread of the disease.

Characterization of Influenza A and B Viruses Circulating in Southern China During the 2017-2018 Season.

The trivalent seasonal influenza vaccine was the only approved and available vaccine during the 2016–2018 influenza seasons. It did not include the B/Yamagata strain. In this study, we report an acute respiratory disease outbreak associated with influenza B/Yamagata infections in Guangzhou, Southern China (January through March, 2018). Among the 9914 patients, 2241 (22.6%) were positive for the influenza B virus, with only 312 (3.1%) positive for the influenza A virus. The influenza B/Yamagata lineage dominated during this period in Southern China. The highest incidence of influenza A virus infection occurred in the children aged 5–14 years. In contrast, populations across all age groups were susceptible to the influenza B virus. Phylogenetic, mutations, and 3D structure analyses of hemagglutinin (HA) genes were performed to assess the vaccine-virus relatedness. The recommended A/H1N1 vaccine strain (A/Michigan/45/2015) during both 2017–2018 and 2018–2019 was antigen-specific for these circulating isolates (clade 6B.1) in Spring 2018. An outbreak of influenza B/Yamagata (clade 3) infections in 2018 occurred during the absence of the corresponding vaccine during 2016–2018. The recommended influenza B/Yamagata vaccine strain (B/Phuket/3073/2013) for the following season (2018–2019) was antigen-specific. Although there were only a few influenza B/Victoria infections in Spring 2018, five amino acid mutations were identified in the HA antigenic sites of the 19 B/Victoria isolates (clade 1A), when compared with the 2016–2018 B/Victoria vaccine strain. The number was larger than expected and suggested that the influenza B HA gene may be more variable than previously thought. One of the mutations (K180N) was noted to likely alter the epitope and to potentially affect the viral antigenicity. Seven mutations were also identified in the HA antigenic sites of 2018–2020 B/Victoria vaccine strain, of which some or all may reduce immunogenicity and the protective efficacy of the vaccine, perhaps leading to more outbreaks in subsequent seasons. The combined epidemiological, phylogenetic, mutations, and 3D structural analyses of the HA genes of influenza strains reported here contribute to the understanding and evaluation of how HA mutations affect vaccine efficacy, as well as to providing important data for screening and selecting more specific, appropriate, and effective influenza vaccine candidate strains.

A Case-Crossover Study to Investigate the Effects of Atmospheric Particulate Matter Concentrations, Season, and Air Temperature on Accident and Emergency Presentations for Cardiovascular Events in Northern Italy.

Atmospheric particulate matter (PM) has multiple adverse effects on human health, high temperatures are also associated with adverse health outcomes, and the frequency of cardiovascular events (CVEs) varies with season. We investigated a hypothesized increase in PM-related accident and emergency (A&E) presentations for CVE with high temperature, warm season, days of high influenza incidence, and in people with a cancer diagnosis, using a time-stratified case-crossover study design. Outcomes were associations of A&E presentation for CVE with atmospheric PM ≤ 10 μm (PM10), season, and air temperature. PM10 levels in the municipality of residence (exposure variable) were estimated by modeling data from local monitoring stations. Conditional logistic regression models estimated odds ratios (OR) with 95% confidence intervals (CI) for presentations in relation to supposed influencers, adjusting for confounders. Study participants were all who presented at the A&E of a large hospital near Milan, Italy, for a CVE (ICD-9: 390–459) from 1st January 2014 to 31st December 2015. There were 1349 A&E presentations for CVE in 2014–2015 and 5390 control days. Risk of A&E presentation was significantly increased on hot days with OR 1.34 (95%CI 1.05–1.71) per 10 μg/m3 PM10 increment (as mean PM10 on day of presentation, and 1 and 2 days before (lags 0–2)), and (for lag 0) in autumn (OR 1.23, 95%CI 1.09–1.37) and winter (OR 1.18, 95%CI 1.01–1.38). Risks were also significantly increased when PM10 was on lag 1, in people with a cancer diagnosis in the spring and summer months (1.88, 95%CI 1.05–3.37), and on days (lags 0–2) of high influenza incidence (OR 2.34, 95%CI 1.01–5.43). PM10 levels exceeded the 50 μg/m3 “safe” threshold recommended by the WHO and Italian legislation for only 3.8% of days during the warm periods of 2014–2015. Greater risk of A&E presentation for CVE in periods of high PM10 and high temperature suggests that “safe” thresholds for PM10 should be temperature-dependent and that the adverse effects of PM10 will increase as temperatures increase due to climate change.

Estimation of influenza and respiratory syncytial virus hospitalizations using sentinel surveillance data-La Paz, Bolivia. 2012-2017.

ObjectiveThe objective was to estimate the number of hospitalizations associated with influenza and RSV using data from severe acute respiratory infection (SARI) sentinel surveillance from El Alto‐La Paz. Bolivia.MethodsAll persons who met the case definition for SARI at one sentinel hospital had a clinical sample collected and analyzed by rRT‐PCR for influenza and by indirect immunofluorescence for RSV. The SARI‐influenza and SARI‐RSV case counts were stratified by six age groups. The proportion of cases captured in the sentinel hospital in relation to the non‐sentinel hospitals of area was multiplied by the age‐specific census population, to build the denominators. The annual incidence and a 95% confidence interval (CI) were estimated.ResultsDuring 2012‐2017, n = 2606 SARI cases were reported (average incidence 120/100 000 inhabitants [95% CI: 116‐124]); the average incidence of influenza‐associated SARI hospitalization was 15.3/100 000 (95% CI: 14.1‐16.7), and the average incidence of RSV‐associated SARI hospitalization was 9/100 000 inhabitants (95% CI: 8.1‐10.1). The highest incidence of influenza was among those less than one year of age (average 174.7/100 000 [range: 89.1‐299.5]), followed by those one to four years of age (average 51.8/100 000 [range: 19.8‐115.4]) and then those 65 years of age and older (average 47.7/100 000 [range: 18.8‐117]). For RSV, the highest incidence was highest among those less than one year of age (231/100 000 [range: 119.9‐322.9]).ConclusionInfluenza and RSV represent major causes of hospitalization in La Paz, Bolivia—with the highest burden among children under one year of age. Our estimates support current prevention strategies in this age group.

Trends of human influenza infection in Chhattisgarh: a retrospective observational study

Background: Human influenza virus was recognized as a pandemic in 2009 by the World Health Organization (WHO). Since then many newer incidences was recognized in India, but there was no sufficient data from all state of India. This study will provide data from the Chhattisgarh state of India.Methods: It was a retrospective observational study from December 2015 to November 2017. All patient samples with suspected influenza infection were collected and analysed by Real-time reverse polymerase chain reaction (RT-PCR).Results: 341 patients’ sample was collected and analysed; among these samples, 07.9% of patients have all three serotype of influenza positive. Raipur district has the highest incidence of influenza A followed by Durg and Raigarh district of Chhattisgarh. There was no significant difference between male and female who was affected by the influenza virus.Conclusions: The incidence of Human influenza virus is lesser in Chhattisgarh as compare to the average states of India and the state capital has a higher rate of sample collection as well as positive influenza infection.

Co-circulation and persistence of multiple A/H3N2 influenza variants in China

ABSTRACT The spread of influenza A/H3N2 variants possessing the hemagglutinin 121 K mutation and the unexpectedly high incidence of influenza in the 2017–2018 northern hemisphere influenza season have raised serious concerns about the next pandemic. We summarized the national surveillance data of seasonal influenza in China and identified marked differences in influenza epidemics between northern and southern China, particularly the predominating subtype and the presence of an additional summer peak in southern China. Notably, a minor spring peak of influenza caused by a different virus subtype was also observed. We also revealed that the 3C.2a lineage was dominant from the summer of 2015 to the end of the 2015–2016 peak season in China, after which the 3C.2a2 lineage predominated despite the importation and co-circulation of the 121 K variants of 3C.2a1 and 3C.2a3 lineages at the global level. Finally, an analysis based on genetic distances revealed a delay in A/H3N2 vaccine strain update. Overall, our results highlight the complicated circulation pattern of seasonal influenza in China and the necessity for a timely vaccine strain update worldwide.

1265. Application of the ALERT Influenza Trigger for Enhanced Prevention Activities

BackgroundAccurate prediction of the onset of increased influenza activity in a healthcare setting can allow for optimal use of enhanced prevention activities. The ALERT (Above Local Elevated Respiratory Illness Threshold) algorithm, described by Reich et al. (2015), utilizes historical weekly case counts of laboratory-confirmed influenza infections to set a trigger point of cases/week that anticipates elevated disease incidence. This can then be used in real-time, during subsequent influenza seasons, for initiation of enhanced prevention, including masking by nonvaccinated healthcare workers.MethodsHistorical data collected from UnityPoint Health-Des Moines (3-hospital, 800-bed system), between 2011 and 2014, was analyzed using the ALERT method (Reich et al. 2015) to set a threshold number of diagnosed influenza cases per week to predict the start of the influenza season. Each following year the threshold was re-analyzed, adding the most recent year’s data to the historical data set. Our goal was to capture at least 80% of influenza cases within our “ALERT period,” without prolonging the duration of heightened prevention efforts.ResultsFor the initial year of real-time application (2015–2016), the threshold was defined as seven cases. In subsequent years, the threshold was 5. Compared with the 3 years prior, use of the ALERT method resulted in more accurate and consistent identification of the influenza season, including anticipating the increase in cases and defining the total duration of the season.Threshold TriggerOnset Date of Enhanced PreventionTotal Cases per SeasonPercent of Cases Captured During AlertDuration of Alert Period (Weeks)Influenza Season Metrics 2012–2013N/ANovember 15, 201272599%22 2013–2014N/ADecember 30, 201325577%9 2014–2015N/ADecember 11, 201477373%19ALERT Trigger Initiated 2015–20167February 22, 201625087%13 2016–20175January 3, 201779195%17 2017–2018a5December 11, 20171,44598%20 aAs of April 28, 2018.ConclusionThe ALERT method utilizes health system specific historical data to more precisely define the period of high influenza incidence allowing for focused utilization of enhanced measures to prevent transmission. This results in a safer environment, optimal use of resources and improved employee and patient satisfaction.Disclosures All authors: No reported disclosures.

Monthly trends in antimicrobial consumption and influenza incidence at the community level in 2014 in Poland.

INTRODUCTION Antibiotic resistance is nowadays one of the most important public health threats. It is mainly caused by inappropriate antibiotic usage. OBJECTIVES We aimed to characterize the seasonal trends of antimicrobial consumption (AC) and to assess the possible relation between AC and the incidence of influenza at the community level in 2014 in Poland. PATIENTS AND METHODS Influenza incidence, AC, and the number of inhabitants vaccinated against influenza were examined at the community level. The AC was assessed on the basis of sales data and then converted to defined daily doses (DDDs) per 1000 inhabitants per day according to the Anatomical Therapeutic Chemical Classification System and the DDD methodology. The data on the incidence of influenza and influenza-like cases were based on notifications from primary care doctors. RESULTS The majority of antimicrobials were consumed at the community level. The mean community consumption of antibacterials for systemic use in Poland in 2014 was 22.50 DDDs per 1000 inhabitants per day. The most frequently consumed substances were oral amoxicillin, amoxicillin and enzyme inhibitor, and cefuroxime. Two seasonal peaks of AC were observed. Seasonal trends in AC were similar to trends in influenza incidence. The highest AC was observed in a voivodeship with the highest influenza incidence. CONCLUSIONS The extent of outpatient AC and the seasonal coincidence of influenza and AC pose an important risk for antibiotic overuse and misuse, which are the main causes of antibiotic resistance.

Antivirals for influenza-Like Illness? A randomised Controlled trial of Clinical and Cost effectiveness in primary CarE (ALIC4 E): the ALIC4 E protocol

IntroductionEffective management of seasonal and pandemic influenza is a high priority internationally. Guidelines in many countries recommend antiviral treatment for older people and individuals with comorbidity at increased risk of...

Differences Depending on the Etiology of Influenza Epidemics in 2014-2017

The goal is to identify features of epidemic process of influenza depending on the etiology of epidemics to clarification of the forecast for future epidemics. Analysis of epidemics of influenza in Russia conducted according to the Federal center for influenza on morbidity, hospitalization and deaths from influenza in 59 Russian cities. The epidemic of influenza A(H1N1)pdm09 2015–16 different from the mixed epidemics of influenza (A(H3N2) and B) 2014–15 and 2016–17 high development rate, high incidence of influenza and ARI at its peak, the incidence of hospitalization with a diagnosis of «influenza» (14%) and high mortality among the infected (6,0 on 100000). The epidemic of influenza A(H3N2) and B started earlier (December). They had a longer duration and the incidence in the cities and in the country, but less than the incidence at the peak of the epidemic and the incidence of hospitalization with a diagnosis of «influenza» (7.5 and 7.3%) and smaller (8.6 and 20 times) the mortality from the influenza. In these epidemics among the dead was higher than the percentage of children under 14 years and persons over 65 years of age than in the influenza epidemic 2015–16. And among the deaths increased the proportion of persons with chronic lung disease and immunodeficiency, but decreased the proportion of individuals with obesity and diseases of the liver and kidneys. For the period from 2009 to 2017 the tendency to increase the intensity of influenza A(H3N2) epidemics was 2.4 times greater than the decrease in the intensity of epidemic of influenza A(H1N1)pdm09.