High Prevalence Of Viral Infections Research Articles

Ukrainian War Refugee Children With Particularly Severe Viral Infections: A Case Series Report.

The humanitarian crisis in Ukraine in 2022 led to a massive migration of refugees to Poland. Immigrant children, living in overcrowded humanitarian hubs, were exposed to multiple stressful factors likely affecting their immune systems. This case series study aimed to describe a particularly severe course of common viral infections, in Ukrainian refugee children. We present 2 case series of Ukrainian refugee children: 5 hospitalized due to either adenovirus (AdV) and 8 with rotavirus (RV) infection, admitted within 3 months in each case series, recruited retrospectively. Most patients lived in humanitarian hubs and were neglected on admission (dehydrated, with poor hygiene and anxious). All RV infection cases had symptoms of severe gastroenteritis requiring intravenous rehydration. Metabolic acidosis was present in 6 children, and hypoglycemia in 4 participants. None of them were vaccinated against RV. All children with AdV infection had prolonged fever, dyspnea requiring oxygen therapy and hyperinflammation. In 2 AdV infection cases with no clinical improvement and increasing inflammatory markers, intravenous immunoglobulins and glucocorticosteroids were used. The combination of stressful factors and living in overcrowded hubs during the high prevalence of viral infections led to a particularly severe course of viral infections in Ukrainian refugee children.

Epidemiological characterization of viral etiological agents of the central nervous system infections among hospitalized patients in Egypt between 2016 and 2019

Viral infections of the central nervous system (CNS) are common worldwide and result in considerable morbidity and mortality associated with neurologic illness. Until now, there have been no epidemiologic data regarding viruses causing aseptic meningitis, encephalitis, and CNS infections in Egypt. We investigated 1735 archived cerebrospinal fluid samples collected from Egyptian patients between 2016 and 2019 and performed molecular characterization for infection for12 different viruses: herpes simplex viruses 1 and 2 (HSV-1 and HSV-2), varicella-zoster virus (VZV), Epstein–Barr virus (EBV), cytomegalovirus (CMV), human herpesviruses 6 and 7 (HHV-6 and HHV-7), human enteroviruses (HEVs), human parechovirus (HPeV), parvovirus B19 (B19V), adenovirus (AdV), and mumps virus (MuV). All included samples were negative for bacterial infection. Our results indicated a relatively high prevalence of viral infection, with HEVs being the most prevalent viruses, followed by HSV-1, EBV, and then HSV-2. The highest prevalence was among male patients, peaking during the summer. Data obtained from this study will contribute to improving the clinical management of viral infections of the CNS in Egypt.

Epidemiology and Risk Factors for Viral Infections in Pediatric Liver Transplant Recipients and Impact on Outcome.

Infections after liver transplantation (LT) are risk factors for morbidity and mortality. Infections, especially of viral etiologies, still have an impact on the graft function and overall outcome. The aim was to review the epidemiology and risk factors of EBV, CMV and non-EBV non-CMV viral infections and their impacts on outcomes after LT. Demographic, clinical, and laboratory data were retrieved from patients' electronic databases. Over 2 years, 96 patients were transplanted at the Pediatric Liver Centre at Kings College Hospital. The majority of the infections were of viral origin; 73 (76%) patients. The incidence of EBV viremia was 60.4%, CMV infection 35.4%, and other viruses 30%. Older donor age, auxiliary graft, and bacterial infections were risk factors for EBV infection. Younger recipient age, D+R- CMV IgG, and left lateral segment graft were risk factors for CMV infection. More than 70% of patients with non-EBV and CMV viral infections stayed positive post-LT but did not contribute to increased complications. Despite the high prevalence of viral infections, EBV, CMV, and non-EBV non-CMV viral infections were not associated with rejection, morbidity, or mortality. Although some of the risk factors for viral infections are unavoidable, identifying the characteristics and risk pattern will help improve the care for pediatric LT recipients.

Antiviral, Cytotoxic and Antioxidant Effects of Tanacetum Vulgare L. Crude Extract In Vitro.

Due to the high prevalence of viral infections having no specific treatment and the constant emergence of resistant viral strains, searching for effective antiviral compounds is crucial. The present study explores in vitro the antiviral activity of ethanolic extract from aerial parts of. The aim of the current study was to evaluate antiviral activity of ethanolic extract from herbaceous plant. The crude aqueous ethanolic extract from aerial parts of. The results show that the extract has the lowest toxicity on the MDBK cell line and similar cytotoxicity in Hep-2, whereas in the MDCK cells it has more than twice the highest toxicity. Testing the antiviral activity of. The crude extract from aerial parts of the medicinal plant.

First detection of Ostreid herpesvirus 1 in wild Crassostrea gigas in Argentina

Ostreid herpesvirus 1 (OsHV-1) is a DNA virus of the genus Ostreavirus (Malacoherpesviridae family, Herpesvirales order). Worldwide, OsHV-1 and its microvariants have been associated with increased mortality of Pacific oysters, Crassostrea gigas. Adult asymptomatic oysters also have shown a high prevalence of viral infection. As a consequence, surveillance is needed to better describe OsHV-1 diversity, pathogenicity, clinical signs, and geographical distribution. We examined Crassostrea gigas sampled in October 2017 from the inner zone of the Bahía Blanca Estuary, Argentina, and found that 8 of 30 specimens (26.7%) presented macroscopic lesions in mantle tissues. Histological analysis revealed abnormal presentation of mantle epithelial cells and connective tissues. Conventional and real-time PCR conducted on the oyster samples revealed 70% to be positive for presence of OsHV-1 DNA. The nucleotide sequence of the amplicon obtained from one sample using the primer pair IA1/IA2 (targeting ORF 42/43) was 99% identical to OsHV-1 reference as well as µVar strains B and A (KY271630, KY242785.1), sequenced from France and Ireland. This finding represents the first detection of OsHV-1 DNA in a wild population of C. gigas in Argentina in association with gross mantle lesions.

High Prevalence of Viral Infections Among Hospitalized Pneumonia Patients in Equatorial Sarawak, Malaysia.

BackgroundAlthough pneumonia is a known cause of morbidity and mortality in Sarawak, Malaysia, the etiology and epidemiology of pneumonia are not well described in this equatorial region. Routine clinical diagnostics for pneumonia etiology at government hospitals in Sarawak had historically involved only bacterial diagnostics. Viral diagnostics were only obtained through outside consultations.MethodsFrom June 15, 2017 to May 14, 2018, we collected nasopharyngeal swabs from 600 patients of all ages older than 1 month hospitalized with pneumonia at Sibu and Kapit Hospitals. Specimens were examined at our collaborating institutions with a panel of molecular assays for viral pathogens including influenza A (IAV), IBV, ICV, and IDV, human adenovirus (AdV), human enterovirus (EV), human coronavirus (CoV), respiratory syncytial virus subtype A (RSV-A) or RSV-B, and parainfluenza virus (PIV) types 1–4.ResultsOf 599 samples examined, 288 (48%) had molecular evidence of 1 or more respiratory viruses. Overall, the most prevalent virus detected was RSV-A (14.2%) followed by AdV (10.4%) and IAV (10.4%), then RSV-B (6.2%), EV (4.2%), IBV (2.2%), PIV-3 (1.7%), CoV (1.0%), PIV-1 (1.0%), PIV-4 (0.7%), and PIV-2 (0.2%). No specimens were confirmed positive for ICV or IDV.ConclusionsThe high prevalence of viruses detected in this study suggest that respiratory viruses may be responsible for considerable morbidity in equatorial regions such as Sarawak. Access to viral diagnostics are very necessary for medical staff to determine appropriate pneumonia treatments.

Prise en charge néphrologique des patients hémophiles A : difficultés diagnostiques et thérapeutiques illustrées par le cas de 2 patients

Hemophilia A is an X-linked genetic hemorrhagic disorder characterized by a factor VIII deficiency. The availability of secured substitution products has led to a dramatic improvement of life expectancy in hemophiliac patients. Nowadays, adult hemophiliac patients may develop Chronic Kidney Disease (CKD) resulting from age-related comorbidities (hypertension, obesity, diabetes). In addition, the high prevalence of viral infections in this population exposes patients to an increased risk of CKD. The risk of hemorrhage in hemophiliac patients is a challenge for their clinical management, both for diagnostic procedures (kidney biopsy in particular) and for renal replacement therapy (dialysis or renal transplantation) when it is needed. This work provides an update of the literature data concerning the management of hemophiliac patients in nephrology, illustrated by the cases of two patients.

Prevalence and risk factors of HTLV-1/2 and other blood borne infectious diseases among blood donors in Yaounde Central Hospital, Cameroon.

IntroductionTransfusion-transmissible infectious microorganisms including bacteria and viruses are among the greatest threats to blood safety for the recipient. The prevalence and risk factors of HTLV-1/2 and other blood borne infectious diseases were determined among blood donors in Yaounde Central Hospital, Cameroon.MethodsDesign: cross sectional study. Setting: The blood bank unit of Yaounde Central Hospital, Cameroon. Subjects: a consecutive sample of 265 apparently healthy adult blood donors. Investigations: Search for the presence of hepatitis B surface antigen (AgHBs) and antibodies to human T-lymphotropic virus type 1 (anti-HTLV-1/2), human immunodeficiency virus (anti-HIV), hepatitis C virus (anti-HCV) and syphilis and to determine the epidemiological correlates, if any, in the occurrence of HTLV infection.Results77 (29.05%) of the blood donors had serological evidence of infection with at least one pathogen and 4 (5.2%) had dual infections with HTLV-1/2. The overall prevalence of HTLV-1/2, HIV, HCV, HBV and syphilis were 5.7%, 5.3%, 2.6%, 11.7%, 3.8% respectively. Surgical history (Chi2=4.785; P=0.029), scarification (Chi2=6.359; P = 0.012), piercing (Chi2 = 16.353; P = 0.000) and intravenous drug use (Chi2 = 15.660; P = 0.000) were identified as risk factors for HTLV-1/2 infection.ConclusionA relative high prevalence of viral infections and syphilis was recorded among the study participants especially for HTLV-1/2 for which none blood donation is routine screened in our set up. Therefore, a routine screen of blood prior to transfusion should include anti-HTLV-1/2 tests.

A molecular survey for selected viral enteropathogens revealed a limited role of Canine circovirus in the development of canine acute gastroenteritis

Canine circovirus (CanineCV) is a canine virus, whose pathogenetic role is still uncertain. Based on recent data suggesting its role as entheropathogen, a case-control study was conducted between 2013 and 2016 to investigate the association of CanineCV with gastroenteritis in dogs, alone or in combination with other viral pathogens, including canine parvovirus (CPV), canine coronavirus (CCoV) and canine distemper virus (CDV). A total of 219 dogs suffering from acute gastroenteritis disorders and 67 controls randomly recruited among healthy dogs or patients presenting without enteric signs were screened by a panel of real-time (RT-)PCR assays for CanineCV, CPV, CCoV and CDV. A high prevalence of viral infections was detected in dogs with gastroenteritis (77.16%), with CPV representing the most frequently detected enteropathogen, followed by CanineCV and CCoV. While CPV and CCoV infections displayed a strong association with occurrence of acute gastroenteritis (p<0.00001), detection of CanineCV in control dogs (28.35%) occurred with prevalence comparable to that of clinical cases (32.42%), so that its correlation with gastrointestinal disease was not statistically supported (p=0.530988). Different from the clinical cases, where co-infections were frequently observed, all positive samples from the control group contained single infections. Noteworthy, a significant association was calculated between co-infections with CanineCV and occurrence of acute gastroenteritis (p<0.00001). This study supports the role of CanineCV as a co-pathogen in the development of gastrointestinal disease, mainly acting in synergism with other enteric viruses.

Mother–child bed-sharing associated with more wheezing in early childhood

Household crowding, including the number of people sharing the child’s bedroom, may place young children at risk of acute lower respiratory infection [1]. However, crowding may also protect against asthma, according to the hygiene hypothesis [2]. Thus bed-sharing in early childhood might either increase or decrease the risk for asthma. On the other hand, parents may adopt bed-sharing practices that allow for closer monitoring of their already asthmatic children. In a recent review, Koinis-Mitchell et al. [3] suggested that asthma underlies sleep problems as a consequence of sleep disordered breathing and frequent awakenings at night. No studies have yet investigated the associations between bed-sharing and asthmatic symptoms. In the current study, we assessed whether bed-sharing practices protect young children from developing asthmatic symptoms, or place them at risk for these symptoms. In the current population-based prospective cohort study ( N = 5,543) we assessed bed-sharing at ages 2 and 24 months, and wheezing, the most important asthma symptom, at ages 1 through 4 years by questionnaires. Generalized estimating equation models (GEE) were used to assess repeated measures of wheezing, and multinomial regression analysis to assess patterns of wheezing over time. Results indicated that bed-sharing at 2 or 24 months were not associated with wheezing at later ages. However, assessing patterns of wheezing over the preschool years shows that bed-sharing at 24 months is associated with early-only wheezing (i.e. wheezing reported only at ages 1 and 2 years; OR 1.64, CI 1.13–2.37, p < .01), even after controlling for maternal educational level, history of atopy and asthma, smoking, body mass index (BMI), breastfeeding, parity, child ethnicity, gender, gestational age at birth, daycare attendance, pet keeping, eczema, and lower respiratory tract infections. Bed-sharing at 2 and 24 months of age was not associated with wheezing later in the preschool years, or with persistent wheezing over time. However, children who bed-shared with their parents at 24 months of age had higher odds to be in the early-only wheezing group. This suggests that bed-sharing children wheeze more, but only at early ages. The transient nature of these children’s wheezing might be associated with the relatively high prevalence of viral infections in the first years of life. It could also be that parents of early-only wheezers bring their child to the parental bed in order to monitor their breathing. This large longitudinal study is the first to explore the associations between bed- sharing practices and wheezing, and shows important associations between this sleep related parenting practice and children’s asthma symptoms. The Generation R Study is conducted by the Erasmus Medical Centre in close collaboration with the School of Law and the Faculty of Social Sciences at the Erasmus University, Rotterdam, the Municipal Health Service, Rotterdam area, and the Stichting Trombosedienst and Artsenlaboratorium Rijnmond (Star-MDC), Rotterdam. We gratefully acknowledge the contribution of general practitioners, hospitals, midwives and pharamacies in Rotterdam.

In vitro antiviral activity of plant extracts from Asteraceae medicinal plants

BackgroundDue to the high prevalence of viral infections having no specific treatment and the constant appearance of resistant viral strains, the development of novel antiviral agents is essential. The aim of this study was to evaluate the antiviral activity against bovine viral diarrhea virus, herpes simplex virus type 1 (HSV-1), poliovirus type 2 (PV-2) and vesicular stomatitis virus of organic (OE) and aqueous extracts (AE) from: Baccharis gaudichaudiana, B. spicata, Bidens subalternans, Pluchea sagittalis, Tagetes minuta and Tessaria absinthioides. A characterization of the antiviral activity of B. gaudichaudiana OE and AE and the bioassay-guided fractionation of the former and isolation of one active compound is also reported.MethodsThe antiviral activity of the OE and AE of the selected plants was evaluated by reduction of the viral cytopathic effect. Active extracts were then assessed by plaque reduction assays. The antiviral activity of the most active extracts was characterized by evaluating their effect on the pretreatment, the virucidal activity and the effect on the adsorption or post-adsorption period of the viral cycle. The bioassay-guided fractionation of B. gaudichaudiana OE was carried out by column chromatography followed by semipreparative high performance liquid chromatography fractionation of the most active fraction and isolation of an active compound. The antiviral activity of this compound was also evaluated by plaque assay.ResultsB. gaudichaudiana and B. spicata OE were active against PV-2 and VSV. T. absinthioides OE was only active against PV-2. The corresponding three AE were active against HSV-1. B. gaudichaudiana extracts (OE and AE) were the most selective ones with selectivity index (SI) values of 10.9 (PV-2) and >117 (HSV-1). For this reason, both extracts of B. gaudichaudiana were selected to characterize their antiviral effects. Further bioassay-guided fractionation of B. gaudichaudiana OE led to an active fraction, FC (EC50=3.1 μg/ml; SI= 37.9), which showed antiviral activity during the first 4 h of the viral replication cycle of PV-2 and from which the flavonoid apigenin (EC50 = 12.2 ± 3.3 μM) was isolated as a major compound.ConclusionsThe results showed that, among the species studied, B. gaudichaudiana seemed to be the most promising species as a source of antiviral agents.

Child pneumonia: beyond pneumococcal vaccine and 2015.

Impressive gains have been made in child survival over the last decade, including a reduction in deaths due to childhood pneumonia.1 Pneumonia nonetheless remains the main reason why many children still do not live to enjoy their fifth birthday. The Global Coalition Against Child Pneumonia was established in 2009 to provide leadership for World Pneumonia Day, marked each year on November 12 to encourage donors, policy makers, health care providers and the general public to combat the disease. Pneumonia is caused by a wide range of pathogens, the relative importance of which varies between settings. Immunisation has played an important role in preventing pneumonia deaths due to measles, pertussis and Haemophilus influenzae. The availability of the pneumococcal conjugate vaccine, and its support for implementation in high mortality settings by the Global Alliance for Vaccines and Immunizations, has resulted in great optimism as it is likely to prevent a large number of deaths due to pneumococcal pneumonia (and meningitis). However, pneumonia-related deaths in neonates and children will continue to occur, including those due to non-vaccine pneumococcal serotypes, other common bacteria and viruses. The wide range of pathogens and limitations in current diagnostics present major challenges for investments in research and programme implementation for pneumonia. These have been neglected relative to research and programmes for malaria and the human immunodeficiency virus (HIV), which have been based on comprehensive approaches and evidence, and are strong in preventive and curative interventions. For example, malaria has been the focus of 22% of the randomised trials conducted in child health in developing countries in the last decade, while pneumonia represents less than 4%.2 Moreover, malaria research has been integrated into programmes rapidly, with resulting unprecedented gains in disease control and reductions in child mortality due to malaria. For pneumonia a similar approach is needed that goes beyond the introduction of the pneumococcal vaccine. A balanced and comprehensive approach would emphasise other preventive strategies: nutrition and breastfeeding, reduction in indoor air pollution, hand-washing and improved case management. Curative interventions include addressing the rising rates of bacterial resistance, models of community care, the role of zinc, improved outcomes for high-risk patients (malnourished, HIV-infected and neonates), as well as wider availability of oxygen therapy and other methods of respiratory support. Controlled treatment trials in the last decade have established the safety of different approaches to community-based case management of World Health Organization defined non-severe and severe pneumonia in some settings.3,4 Most of these have been in urban and peri-urban areas in south Asia, characterised by low mortality and a high prevalence of viral infection. The challenge is to conduct research in populations with higher mortality, a higher prevalence of bacterial pneumonia, malnutrition and HIV, and where access to care is more challenging. The heterogeneity of populations and uncertainties about the global applicability of research are illustrated by trials evaluating zinc adjunct therapy, where the findings have not been consistent between settings. A recent randomised trial in Uganda reported significant benefit of zinc adjunct therapy with regard to mortality, particularly in HIV-infected children.5 Understanding where evidence does and does not apply is a challenge for balanced and comprehensive pneumonia control programmes. Understanding the social and health system determinants of pneumonia causation and death is crucial to developing comprehensive approaches. Incorporating comprehensive approaches in national plans for child survival is the way to proceed. It won’t be as easy as a single vaccine, but a more comprehensive approach will take countries beyond this—and 2015—in tackling pneumonia.

Spectrum of Respiratory Viruses in Children With Community-acquired Pneumonia

Community-acquired pneumonia (CAP) remains a significant cause for childhood morbidity worldwide. We designed a study with the objective of describing the frequency of respiratory viruses, especially rhinovirus (RV), human metapneumovirus (HMPV) and human bocavirus (HBoV) in hospitalized children with CAP. A 6-year prospective study was conducted in children <14 years old admitted to the Pediatrics Department of the Severo Ochoa Hospital (Spain) with CAP. We studied the frequency of 16 respiratory viruses in nasopharyngeal aspirates. Clinical characteristics of respiratory syncytial virus (RSV)-only infections were compared with those of RV, HMPV and HBoV single infections. A viral pathogen was identified in 649 (73.4%) of 884 hospitalized children with CAP. Viral coinfections were detected in 30%. The rate of viral detection was significantly greater in infants <18 months (83%) than in older children (67%) (P < 0.001). The most frequently detected virus was RSV with 41.6% of positive patients followed by RV (26.2%), HBoV (17.8%), adenovirus (17.8%), HMPV (7%) and parainfluenza (7%). RSV was the most frequent virus in children <18 months, but RV was most common in the eldest group (P < 0.001). After stratifying by age, we found some significant differences among RSV, RV, HBoV and HMPV-associated infections. The high prevalence of viral infections supports the role of respiratory viruses, mainly RSV, RV, HBoV and HMPV in CAP of children requiring hospitalization. These findings help us to understand the etiologic disease burden and to guide research and public health policy.

Abstract SY08-01: Cancer in immunosuppressed populations: Epidemiologic clues to causation

Abstract Epidemiologic studies of immunosuppressed populations (HIV-infected people and solid organ transplant recipients) can identify candidate malignancies where infection, immunity, and inflammation are likely to be etiologically important. Such studies have revealed markedly elevated risk for cancers linked to oncogenic viral infections, e.g., Kaposi sarcoma (caused by human herpesvirus 8), some non-Hodgkin lymphoma subtypes and Hodgkin lymphoma (Epstein Barr virus), anogenital cancers (human papillomavirus), and liver cancer (hepatitis B and C viruses). For these cancers, the heightened risk arises from a high prevalence of viral infection and/or loss of immune control of the infection. In contrast, risk is not elevated in immunosuppressed populations for common malignancies not strongly linked to infection (e.g., colon, prostate, and breast cancers), arguing against a more general role for immune surveillance in protecting healthy people from cancer. For a few remaining cancers, an elevated risk is observed among both HIV-infected people and transplant recipients, but the increase is not as great as for malignancies known to be caused by viruses, or data are less clearcut. Examples include various skin cancers, lung cancer, and multiple myeloma. These increased risks suggest that specific infections (with either a known or unknown agent) or altered immunity are relevant for development of these malignancies. Another possibility is that repeated or chronic infections with diverse microbes, or chronic inflammation, play a role. Citation Format: Eric A. Engels. Cancer in immunosuppressed populations: Epidemiologic clues to causation [abstract]. In: Proceedings of the AACR 101st Annual Meeting 2010; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr SY08-01

Abstract 2171: Viral infection as an etiological risk factor for diffuse large B cell lymphoma (DLBCL): A comparative study between Egypt and Sweden

Abstract Objective: Previous studies have reported an association between increased risk of diffuse large B cell lymphoma (DLBCL) and hepatitis B, hepatitis C, Epstein Barr viruses infection in some countries including Egypt. We therefore assume that the progression of DLBCL might be enhanced by chronic viral infection and that specific pathways can be targeted for the prevention and therapy of DLBCL. Our aim is to assess the possible role of viral infections in the development and progression of DLBCL by determining the genetic profile of DLBCL cases from areas with different prevalence of viral infection. Methods: Gene expression profile of well-characterized cases of DLBCL (30 from Egypt and 16 from Sweden) together with their normal matched controls was studied using the Affymetrix Human GeneShip U133 plus 2.0. Data sets were assigned to two groups (Swedish and Egyptian) and the expression profiles were compared to identify genes that were differentially expressed between the groups. Lists were compiled of all genes for which expression was differentially either induced or suppressed &amp;gt;2-fold between groups. The gene lists were categorized according to their biological functions as described in GeneSpring and Ingenuity. Validation studies were done using RT-PCR, in situ hybridization and immunohistovhemistry. Results: After statistical analysis and filtration by fold change more than 2 times, 2790 genes entities were differentially expressed in the two groups. 1) STAT 2 was highly expressed in Swedish patients and the difference between the two patient groups is clearly indicated in the IFN signaling pathway, 2) higher expression of antigen presentation gene in Egyptian patients compared to Swedish patients (HLA-DQA1, HLA-B, MHCIIα, MHCIα), and 3) higher expression genes in wnt signaling pathway in Egyptian patients compared to Swedish patients (wnt7A, β catenine, CK1). Conclusions: Chronic viral infection could be a risk factor for DLBCL in Egypt (which represents an area with high prevalence of viral infection) but not in Sweden. Note: This abstract was not presented at the AACR 101st Annual Meeting 2010 because the presenter was unable to attend. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 2171.

Swine CAFOs &amp; Novel H1N1 Flu: Separating Facts from Fears

With cases documented in more than 170 countries, the global swine flu pandemic that erupted in spring 2009 remains a serious public health problem. Caused by a strain of H1N1 influenza virus, which is normally found in pigs, the flu now known as novel H1N1 has so far been less severe than regular seasonal flu in terms of deaths and hospitalizations. Yet given its remarkable capacity for human-to-human transmission and a widespread lack of immunity among potentially exposed people, it’s likely the number of cases will rise during the flu season later this fall and winter, according to many public health experts. Given that possibility, enormous resources are being mobilized to address novel H1N1, with an emphasis on vaccine development, education, and efforts to its limit its movements among human communities. Yet one potential source of the original outbreak—factory swine farming in concentrated animal feeding operations (CAFOs)—has received comparatively little attention by public health officials. CAFOs house animals by the thousands in crowded indoor facilities. But the same economy-of-scale efficiencies that allow CAFOs to produce affordable meat for so many consumers also facilitate the mutation of viral pathogens into novel strains that can be passed on to farm workers and veterinarians, according to Gregory Gray, director of the Center for Emerging Infectious Diseases at the University of Iowa College of Public Health. “When respiratory viruses get into these confinement facilities, they have continual opportunity to replicate, mutate, reassort, and recombine into novel strains,” Gray explains. “The best surrogates we can find in the human population are prisons, military bases, ships, or schools. But respiratory viruses can run quickly through these [human] populations and then burn out, whereas in CAFOs—which often have continual introductions of [unexposed] animals—there’s a much greater potential for the viruses to spread and become endemic.” Gray says workers exposed routinely to livestock can pass these zoonotic infections—which transmit readily among humans and animals—on to the wider public. However, public health agencies that monitor risks from zoonotic infections routinely overlook CAFO workers, according to Ellen Silbergeld, a professor at the Johns Hopkins Bloomberg School of Public Health. And animal disease sampling data collected by the food animal industry typically are not shared publicly, according to Gray, although such data could reveal how novel pathogens evolve in CAFOs and how they might move among animals, workers, and the broader community. Experts believe that without these data, society has a diminished capacity to detect and respond to new zoonotic threats before they become more widespread.

Etiology of Community-Acquired Pneumonia in Hospitalized School-Age Children: Evidence for High Prevalence of Viral Infections

The Pediatric Infectious Disease Journal: March 2005 - Volume 24 - Issue 3 - p 291 doi: 10.1097/01.inf.0000154225.73516.d8

Etiology of community-acquired pneumonia in hospitalized school-age children: evidence for high prevalence of viral infections.

Background. Community-acquired pneumonia (CAP) in young children is most commonly associated with viral infections; however, the role of viruses in CAP of school-age children is still inconclusive. Methods. Seventy-five school-age children hospitalized with CAP were prospectively evaluated for the presence of viral and bacterial pathogens. Nasopharyngeal washes were examined by polymerase chain reaction for viruses and atypical bacteria. Antibody assays to detect bacterial pathogens in acute-phase and convalescent-phase serum samples were also performed. Results. A viral infection was identified in 65% of cases. Rhinovirus RNA was detected in 45% of patients; infection with another virus occurred in 31%. The most common bacterial pathogen was Mycoplasma pneumoniae, which was diagnosed in 35% of cases. Chlamydia pneumoniae DNA was not detected in any patient; results of serological tests were positive in only 2 patients (3%). Mixed infections were documented in 35% of patients, and the majority were a viral-bacterial combination. Conclusions. The high prevalence of viral and mixed viral-bacterial infections supports the notion that the presence of a virus, acting either as a direct or an indirect pathogen, may be the rule rather than the exception in the development of CAP in school-age children requiring hospitalization.

High prevalence of viral infection in adults with homozygous and heterozygous alpha 1-antitrypsin deficiency and chronic liver disease.

To determine the prevalence of chronic liver disease in adults with homozygous (Pi ZZ) and heterozygous (Pi Z) alpha 1-antitrypsin deficiency and to assess the presence of other possible risk factors for the development of chronic active hepatitis and cirrhosis of the liver in these patients. Cross-sectional study. A referral-based university hospital. Consecutive patients (164) with the Pi ZZ and Pi Z phenotype with and without chronic liver disease. The presence of antibody to hepatitis C virus (anti-HCV) was determined using an assay incorporating synthetic peptide antigen from capsid protein (United Biomedical [UBI] assay) and a second-generation enzyme immunoassay (Abbott test); the presence of antibody to hepatitis B virus (anti-HBV) was determined using radioimmunoassays incorporating hepatitis B surface antigen (HBsAg) and hepatitis B core antigen (HBcAg); assays for antinuclear antibody and antimitochondrial antibody (M2 subtype) were also done, and alcohol abuse was assessed by history. Among patients with cirrhosis (32%), 62% were anti-HCV positive by the Abbott test (P = 0.006), and 41% were anti-HCV positive by the UBI assay (P = 0.007). Thirty-three percent of patients with cirrhosis had hepatitis B virus (HBV) infection (P = 0.01); 41% had a history of alcoholism; and 12% had features of autoimmune liver disease. Only five patients (9%) with cirrhosis had no other risk factor for chronic liver disease. Among patients with chronic active hepatitis (7%), 80% were anti-HCV positive by the Abbott test (P = 0.002), and 75% were anti-HCV positive by the UBI assay (P less than 0.001). Thirty percent of patients with chronic active hepatitis had HBV infection (P = 0.023); 18% had autoimmune hepatitis; and 8% abused alcohol. Only two patients (17%) had no additional risk factor for the development of chronic active hepatitis. Among patients with steatosis of the liver (48%), 5% were anti-HCV positive by the Abbott test, and none were anti-HCV positive by the UBI assay; 18% had serologic evidence of past HBV infection, and 28% abused alcohol. Among patients without chronic liver disease (13%), no viral infection could be found; 9% were alcoholics. Chronic liver disease in patients with alpha 1-antitrypsin deficiency is associated with a high prevalence of viral infection; this infection, rather than alpha 1-antitrypsin deficiency alone, may be the cause of the liver disease in such patients.