Influenza-like Cases Research Articles

Epidemiological characteristics of human respiratory syncytial virus in influenza-like illness in Shenzhen City from 2019 to 2023

Objective: To understand the epidemiological characteristics of human respiratory syncytial virus (HRSV) among cases presenting with influenza-like illness (ILI) in Shenzhen City from 2019 to 2023. Methods: Respiratory specimens were collected from two national sentinel hospitals in Shenzhen from March 2019 to December 2023, specifically targeting cases of ILI. The real-time PCR method was used for the detection and genotyping of HRSV. Basic demographic information was collected and used for the epidemiological analysis. Results: A total of 9 278 respiratory specimens of influenza-like cases were collected and detected, with a total positive rate of 4.77% (443/9 278) for HRSV. In 2021 (8.48%, 167/1 970), the positive rate of HRSV was significantly higher than in 2019 (3.35%, 52/1 552), 2022 (1.80%, 39/2 169), and 2023 (4.49%, 133/2 960), and the difference was statistically significant (χ2=102.395, P<0.001). The prevalence of HRSV was mainly in summer and early autumn (September), and there was an abnormal increase in the positive rate of HRSV in winter 2022. The highest positive rate of HRSV was in children under five years old (9.84%, 330/335). The typing results showed that in 2022, the prevalence of HRSV-A was predominant (71.79%, 28/39), and in 2023, HRSV-A and HRSV-B subtypes coexisted. Conclusions: The prevalence of HRSV in Shenzhen from 2019 to 2023 has obvious seasonality, mainly in summer and early autumn. Children under five years old are the main population of HRSV infections.

Epidemiological characteristics of human respiratory syncytial virus in Hubei Province from 2016 to 2023

Objective: To analyze the epidemiological characteristics of human respiratory syncytial virus (HRSV) in patients with acute respiratory infection (ARIs) in sentinel hospitals of the Hubei influenza surveillance network from 2016 to 2023. Methods: ARIs samples [including influenza-like cases (ILI) and severe acute respiratory infection (SARI)] were collected from influenza surveillance sentinel hospitals in Hubei Province from 2016 to 2023, and case information was collected. HRSV virus nucleic acid typing was performed by fluorescence quantitative PCR method, and the data were collated, plotted and analyzed. Results: From 2016 to 2023, 12 779 cases of ILI and 9 166 cases of SARI were collected. The positive rate of HRSV was the highest in<5 years of age group [15.77% (168/1 065)], among which the positive rate was the highest in 2 to 5 years of age group of ILI cases [13.60% (31/228)], and the positive rate was the highest in 0 to 2 years of age group of SARI cases [25.97% (60/231)] (all P values<0.001). The positive rate of HRSV in SARI cases was 2.31%-25.97%, higher than that in ILI cases (0-13.60%) (P=0.016). HRSV was prevalent in autumn and winter from 2016 to 2020 and in spring in 2023. Alternating epidemics of HRSV virus type A and B in Hubei Province from 2016 to 2023 (dominant epidemics of type B in 2016 and 2020; dominant epidemics of type A in 2017-2019 and 2023). Conclusion: SARI and ILI patients under five years old are the main infection groups of HRSV. The seasonal prevalence characteristics of HRSV in Hubei Province from 2016 to 2023 shift from autumn and winter to spring.

Analysis of seasonal H3N2 influenza virus epidemic characteristics and whole genome features in Jining City from 2018 to 2023.

Seasonal H3N2 influenza virus, known for its rapid evolution, poses a serious threat to human health. This study focuses on analyzing the influenza virus trends in Jining City (2018-2023) and understanding the evolving nature of H3N2 strains. Data on influenza-like cases were gathered from Jining City's sentinel hospitals: Jining First People's Hospital and Rencheng Maternal and Child Health Hospital, using the Chinese Influenza Surveillance Information System. Over the period from 2018 to 2023, 7844 throat swab specimens were assessed using real-time fluorescence quantitative PCR for influenza virus nucleic acid detection. For cases positive for seasonal H3N2 influenza virus, virus isolation was followed by whole genome sequencing. Evolutionary trees were built for the eight gene segments, and protein variation analysis was performed. From 2018 to 2023, influenza-like cases in Jining City represented 6.99% (237 299/3 397 247) of outpatient visits, peaking in December and January. Influenza virus was detected in 15.67% (1229/7844) of cases, primarily from December to February. Notably, no cases were found in the 2020-2021 season. Full genome sequencing was conducted on 70 seasonal H3N2 strains, revealing distinct evolutionary branches across seasons. Significant antigenic site variations in the HA protein were noted. No resistance mutations to inhibitors were found, but some strains exhibited mutations in PA, NS1, PA-X, and PB1-F2. Influenza trends in Jining City saw significant shifts in the 2020-2021 and 2022-2023 seasons. Seasonal H3N2 exhibited rapid evolution. Sustained vigilance is imperative for vaccine updates and antiviral selection.

Pathogenic agents causing acute respiratory tract infections in pediatric patients in Spring, 2023, in Beijing

Objective: To explore the pathogenic agents of acute respiratory infection (ARI) in children in Beijing. Methods: In the cross-sectional study, 3 groups of children from different departments were enrolled from Feb 6th, 2023 (6th week) to May 28th (21th week), 2023, including influenza-like case group from emergency department for nucleic acid testing of influenza virus (Flu) and human metapneumovirus (HMPV), the outpatient ARI group under nucleic acid testing for Flu, respiratory syncytial virus (RSV), adenovirus (ADV), and parainfluenza virus (PIV), and the inpatient ARI group under nucleic acid testing for Flu, RSV, HMPV, ADV, human bocavirus (HBoV), Rhinovirus (Rh), PIV, coronavirus (HCoV), Mycoplasma pneumoniae (Mp) and Chlamydia pneumonia (Cp). Results: There were 320 influenza-like cases enrolled, including 192 males and 128 females, aged 4.7 (3.6, 6.9) years, and 117 cases (36.6%) positive for Flu A, which contained similar proportion of pandemic H1N1 (H1N1) 47.0% (55/117) and H3N2 53.0% (62/117), and 13 cases for HMPV 4.1% (13/320). The rate of Flu reached its peak at the 10th week, with H1N1 as the predominant one from the 6th to 9th week (10.0%-50.0%) and then H3N2 from the 10th to 16th week (15.0%-90.0%). HMPV was detected from the 15th week 5.0% (1/20), and then reached to 30.0% (6/20) at the 20th week. In the outpatient ARI group, 7 573 were enrolled, including 4 131 males and 3 442 females, aged 4.0 (2.1, 5.3) years, and the highest positive rate for RSV 32.9% (2 491/7 573), followed by Flu A 12.1% (915/7 573). The dominant one was Flu A in weeks 6-14 (23.2%-74.7%), then RSV in the 15th week 24.8% (36/145). In the inpatient ARI group, 1 391 patients were enrolled, including 804 males and 587 females, aged 3.3 (0.4, 5.8) years, and the highest positive rate for Rh 18.7% (260/1 391), followed by RSV 12.4% (173/1 391), Flu A 10.2% (142/1 391, of which 116 cases (81.7%) were H1N1, and 26 cases (18.3%) were H3N2) and HMPV 3.1% (43/1 391). H1N1 was detected from the 7th week 10% (6/60), to peak in the 11th week 31.8% (21/66). H3N2 was detected from the 8th week 1.5% (1/68), and then kept in low level. The proportion of H1N1 among Flu was 81.7% (116/142) in the inpatient ARI group. RSV was detected from 12th week 1.3% (1/80), reaching 30.4% (35/115) at 19th week. The positive rate of HMPV reached 12.1% (14/116) at 21th week. Conclusions: In the spring of 2023, the first one in Beijing is the Flu epidemic, with H1N1 being the predominant one in the early stage and H3N2 in the later stage. Then, there is a postponed RSV epidemic and an increased HMPV detection. In addition, nucleic acid testing for outpatient children should be strengthened to provide early warning of epidemics.

Analysis of parainfluenza virus infection in acute respiratory tract infection adult cases in Shanghai, 2015-2021

Objective: To study the infection status and epidemiological characteristics of parainfluenza virus (PIV) in acute respiratory tract infection adult cases in Shanghai from 2015 to 2021, and to provide a scientific basis for preventing and controlling PIV. Methods: Acute respiratory tract infections were collected from 13 hospitals in Shanghai from 2015 to 2021. Relevant information was registered, and respiratory specimens were sampled to detect respiratory pathogens by multiplex PCR. Results: A total of 5 104 adult acute respiratory tract infection cases were included; the overall positive rate of the respiratory pathogens was 29.37% (1 499/5 104). The positive rate of PIV was 2.61% (133/5 104), compared with 2.32% (55/2 369) and 2.85% (78/2 735) in influenza-like cases (ILI) and severe acute respiratory infection (SARI) cases, respectively. Among them, PIV3 accounted for the highest proportion (62.41%, 83/133), followed by PIV1 (18.80%, 25/133), PIV2 (9.77%, 13/133), and PIV4 (9.02%, 12/133). The incidence of PIV-positive cases was mainly distributed in the first and second quarters, accounting for 62.41% (83/133). The difference in the incidence in each quarter was significant (χ2=24.78, P<0.001). Mixed infection accounted for 18.80% (25/133) of 133 PIV-positive cases, the mixed infection rates of ILI and SARI were 18.18% (10/55) and 19.23% (15/78), respectively, and the main mixed pathogen of PIV was coronavirus 229E. Conclusions: There are a certain proportion of PIV-positive acute respiratory tract infection cases in Shanghai. It is necessary to strengthen the etiological surveillance in acute respiratory tract infection cases, especially the mixed infection of PIV and other pathogens.

Multicenter, randomized controlled, open label evaluation of the efficacy and safety of arbidol hydrochloride tablets in the treatment of influenza-like cases

ObjectiveTo study the efficacy and safety of arbidol hydrochloride tablets as a treatment for influenza-like diseases.MethodsIn this multicenter, randomized, controlled, open label study, a total of 412 influenza-like cases were collected from 14 hospitals in seven regions of Hebei Province from September 2021 to March 2022. Patients were randomly divided into two groups. The control group (n = 207) were administered oseltamivir phosphate capsules for five days and the experimental group (n = 205) were administered arbidol hydrochloride tablets for five days. The primary endpoint was the time to normal body temperature, and the secondary endpoints included the time to remission of influenza symptoms, incidence of influenza-like complications, and incidence of adverse reactions.ResultsBefore treatment, there was no significant difference between the two groups in general conditions, blood routine, body temperature, or symptom severity. After treatment, there was no significant difference between the groups in the mean time to fever remission (59.24 h ± 25.21 vs. 61.05 h ± 29.47) or the mean time to remission of influenza symptoms (57.31 h ± 30.19 vs. 62.02 h ± 32.08). Survival analyses using Log-rank and Wilcoxon bilateral tests showed that there was no significant difference in fever relief time or influenza symptom relief time between the two groups. Regarding the incidence of complications and adverse events, there was only one case of tracheitis, one case of nausea, one case of vomiting, and one case of dizziness in the control group. In the experimental group, there was one case of nausea, one case of vomiting, and one case of drowsiness. In addition, one patient in the control group was hospitalized for urinary calculi.ConclusionThere was no significant difference between the patients with influenza-like cases treated with arbidol hydrochloride tablets and those treated with oseltamivir phosphate capsules. Further, the patients treated with arbidol hydrochloride tablets had fewer adverse reactions, and thus, the tablets were safe to use.

Epidemiologic characteristics and influencing factors of influenza outbreaks in Guangdong Province, 2015-2022

Objective: To grasp the epidemiological characteristics of influenza outbreaks in Guangdong Province by analyzing the outbreaks of influenza-like cases reported in Guangdong Province from January 2015 to the end of August 2022. Methods: In response to the outbreak of epidemics in Guangdong Province from 2015 to 2022, information on on-site epidemic control was collected, and epidemiological analysis was conducted to describe the characteristics of the epidemics. The factors that influence the intensity and duration of the outbreak were determined through a logistic regression model. Results: A total of 1 901 influenza outbreaks were reported in Guangdong Province, with an overall incidence of 2.05%. Most outbreak reports occurred from November to January of the following year (50.24%, 955/1 901) and from April to June (29.88%, 568/1 901). A total of 59.23% (1 126/1 901) of the outbreaks were reported in the Pearl River Delta region, and primary and secondary schools were the main places where outbreaks occurred (88.01%, 1 673/1 901). Outbreaks with 10-29 cases were the most common (66.18%, 1 258/1 901), and most outbreaks lasted less than seven days (50.93%,906/1 779). The size of the outbreak was related to the nursery school (aOR=0.38, 95%CI:0.15-0.93), the Pearl River Delta region (aOR=0.60, 95%CI:0.44-0.83), the time interval between the onset of the first case and the time of report (>7 days compared with ≤3 days: aOR=3.01, 95%CI:1.84-4.90), the influenza A(H1N1) (aOR=2.02, 95%CI:1.15-3.55) and the influenza B (Yamagata) (aOR=2.94, 95%CI: 1.50-5.76). The duration of outbreaks was related to school closures (aOR=0.65, 95%CI: 0.47-0.89), the Pearl River Delta region (aOR=0.65, 95%CI: 0.50-0.83) and the time interval between the onset of the first case and the time of report (>7 days compared with ≤3 days: aOR=13.33, 95%CI: 8.80-20.19; 4-7 days compared with ≤3 days: aOR=2.56, 95%CI: 1.81-3.61). Conclusions: An influenza outbreak in Guangdong Province exhibits two peaks, one in the winter and spring seasons and the other in the summer. Primary and secondary schools are high-risk areas, and early reporting of outbreaks is critical for controlling influenza outbreaks in schools. Furthermore, comprehensive measures should be taken to prevent the spread of the epidemic.

Municipal and neighbourhood level wastewater surveillance and subtyping of an influenza virus outbreak

Recurrent influenza epidemics and pandemic potential are significant risks to global health. Public health authorities use clinical surveillance to locate and monitor influenza and influenza-like cases and outbreaks to mitigate hospitalizations and deaths. Currently, global integration of clinical surveillance is the only reliable method for reporting influenza types and subtypes to warn of emergent pandemic strains. The utility of wastewater surveillance (WWS) during the COVID-19 pandemic as a less resource intensive replacement or complement for clinical surveillance has been predicated on analyzing viral fragments in wastewater. We show here that influenza virus targets are stable in wastewater and partitions favorably to the solids fraction. By quantifying, typing, and subtyping the virus in municipal wastewater and primary sludge during a community outbreak, we forecasted a citywide flu outbreak with a 17-day lead time and provided population-level viral subtyping in near real-time to show the feasibility of influenza virus WWS at the municipal and neighbourhood levels in near real time using minimal resources and infrastructure.

Application of a ddRT-PCR to quantify seasonal influenza virus for viral isolation

Viral isolation in cell cultures has been regarded for decades as the “gold standard” for the laboratory diagnosis of influenza viral infections. Not all viral strains could be isolated from clinical samples. This study aimed to quantify the viral load in the samples before isolation to save working time and improve working efficiency. Four hundred samples from patients with influenza-like cases were confirmed pdmH1N1 positive (200 cases) and B Victoria (BV) positive (200 cases) by whole-genome sequencing and analyzed by ddPCR for viral load in samples before isolation, and isolation results were verified by hemagglutination (HA) assay and hemagglutination-inhibition (HI) tests. Probit regression analysis was used to calculate the isolation viral load limit with a 95% probability level by SPSS 19.0 software. The results showed that the isolation limit of viral load was 4.9 × 104 (95% CI: 2.5 × 104–9.0 × 104) copies/mL for pdmH1N1 and 1.9 × 104 (95% CI: 7.8 × 103–3.6 × 104) copies/mL for BV. The isolation rate of clinical samples is positively correlated with the viral load in clinical samples, which can be used for viral culture, providing important guidance for daily work.

Forecasting the Potential Number of Influenza-like Illness Cases by Fusing Internet Public Opinion

As influenza viruses mutate rapidly, a prediction model for potential outbreaks of influenza-like illnesses helps detect the spread of the illnesses in real time. In order to create a better prediction model, in this study, in addition to using the traditional hydrological and atmospheric data, features, such as popular search keywords on Google Trends, public holiday information, population density, air quality indices, and the numbers of COVID-19 confirmed cases, were also used to train the model in this research. Furthermore, Random Forest and XGBoost were combined and used in the proposed prediction model to increase the prediction accuracy. The training data used in this research were the historical data taken from 2016 to 2021. In our experiments, different combinations of features were tested. The results show that features, such as popular search keywords on Google Trends, the numbers of COVID-19 confirmed cases, and air quality indices can improve the outcome of the prediction model. The evaluation results showed that the error rate between the predicted results and the actual number of influenza-like cases form Week 15 to Week 18 fell to less than 5%. The outbreak of COVID-19 in Taiwan began in Week 19 and resulted in a sharp rise in the number of clinic or hospital visits by patients of influenza-like illnesses. After that, from Week 21 to Week 26, the error rate between the predicted and actual numbers of influenza-like cases in the later period dropped down to 13%. It can be confirmed from the actual experimental results in this research that the use of the ensemble learning prediction model proposed in this research can accurately predict the trend of influenza-like cases.

Epidemiological characteristics of influenza and characteristics of hemagglutinin gene of B-Victoria strains in Hebei Province from 2018 to 2019

Objective: To understand the epidemiological characteristics of influenza in Hebei Province from 2018 to 2019, and to analyze the characteristics and variation of hemagglutinin(HA) gene of influenza B-Victoria(BV) strains. Methods: Throat swab specimens of influenza-like cases within 3 days of fever were collected from 28 sentinel hospitals in Hebei province, meanwhile, The surveillance data was collected by the Chinese National Influenza Surveillance Network from April 2018 to March 2019, Throat swab specimens were collected from patients with influenza-like symptoms in sentinel hospitals, and tested by RT-PCR and virus isolation. 14 influenza B-Victoria strains from different regions were selected to sequence HA gene, Phylogenetic tree and the molecular characteristics were analyzed by DNASTAR 7.0 and Mega-X software. Results: From 2018 to 2019, A total of 99 266 cases of influenza-like illness (ILI) were detected from 4 689 103 cases by 28 influenza sentinel hospitals in Hebei Province, the visit percentage of ILI was 2.12%. During the period, 18 730 samples were detected, and 2 752(14.69%) samples were positive tested by RT-PCR, the peak was in the third week of 2019(44.92%), In the early stage of epidemic season, Influenza A(H1N1)pdm09 virus was the main type, while BV virus was the main type in the late stage. HA gene sequence analysis showed that the 14 BV viruses belonged to 162-164 amino acid deletion strains, the amino acid homology between HA sequences was 97.16%-100.00%, and 97.16%-98.95% compared with the vaccine strain B/Colorado/06/2017 recommended by WHO. Compared with the vaccine strains, 14 strains involved 11 amino acid site mutations. Conclusion: Influenza was prevalent in winter and spring in Hebei province from 2018 to 2019, Multiple mutations in antigenic sites of BV viruses might be related to the outbreaks.

Epidemic situation of the complex seasonality of imported influenza A and B virus transmission in Guangxi ports of China

Background/aimAnalysis of the characteristics of influenza virus in imported cases in Guangxi province of China.Materials and methodsThroat swabs of imported cases with influenza-like symptoms were detected by real-time PCR from July 2016 to December 2019.Results1292 laboratory detections of influenza were reported in 3974 influenza-like cases, of which 71.67% (926) were influenza A. The ratio of test positive was 32.82%. The proportion of detections of influenza B was 28.33% (366). A total of 70.51% of the cases mostly came from Vietnam (911). A total of 86.76% (1121) of the cases were imported from Dongxing Port, Nanning Airport, and Pingxiang Port. There was no statistical difference in all age groups. At the same time, 3 of the untyped A-type specimens were sequenced by next-generation sequencing. Among them, the sequences of 2 specimens from Vietnam had high homology with the influenza strain H3N2 in Hong Kong in 2017. The specimen sequence from Thailand is highly homologous to the influenza pandemic strain H1N1 in Brisbane, Australia in 2018.ConclusionImported influenza cases in Guangxi have occurred throughout the year, with higher numbers in winter and spring. The cases mostly came from Vietnam with influenza A. Relevant measures should be taken to control the further spread of the virus.

Investigation and Analysis of a Cluster, of Influenza-like Cases in an Ethnic High School in Jingxi City, Guangxi

Objective: Analyze the epidemiological characteristics of a cluster of influenza-like cases in a national high school in Jingxi City, Guangxi, to provide a basis for formulating influenza prevention and control strategies and measures. Methods: Descriptive epidemiological methods are used to describe and analyze the epidemiological characteristics of influenza-like cases. Results: A total of 48 student influenza-like cases were reported from April 8 to 21,2020, with an attack rate of 4.46% (48/1076), 20 males and 28 females, with a male-to-female ratio of 1:1.4; the main clinical feature is fever Accompanied by sore throat, cough, dry throat, sore throat, tonsil enlargement and other respiratory symptoms. The patient’s boby temperature was as high as 38.9°C, There were 15 people at 38.6-38.9°C, accounting for 31.25%, and 33 people at 38.0-38.5°C, accounting for 67.75%. The time of onset was April 14 with the largest number of patients, accounting for 18.75%. The incidence class was based on 2017 (15), The number of patients in the class was the largest, accounting for 16.67%. The age of onset was the largest in the 18-year-old age group, accounting for 72.92%; three batches of throat swab specimens from some patients were collected, a total of 29 people were sent to the Guangxi Baise City Center for Disease Control and prevention for experiment Laboratory tests showed that all samples in the three batches were negative for the nucleic acid test of the new coronavirus pneumonia virus and the influenza virus. Conclusion: According to the epidemiological characteristics, combined with the patient’s clinical manifestations and laboratory test results, the epidemic was determined to be a cluster of influenza-like cases. After timely prevention and control measures were taken, the epidemic was effectively controlled.

Reflections on the health-work relation and exposure to COVID-19.

The pandemic of the new coronavirus (SARS-CoV-2) has brought theoretical and practical challenges in the scientific and social fields, intensifying already existing problems, such as the relationship between working conditions and the health of the working class. Workers are key players both in the control and the spread of the disease, and especially those in the healthcare sector since they are necessarily in contact with other people. Therefore, the present article aimed to reflect, from an occupational health perspective, on the guidelines of the Brazilian Ministry of Health, expressed in publications on the clinical management of suspected, confirmed, or influenza-like cases, and the recommendations for the protection of workers who are in charge of treating the 2019 novel coronavirus disease. The present analysis highlighted the importance of the development of more comprehensive measures by the State that are in line with the reality of many workers in the context of the pandemic, thus transcending the prescriptive, biological, and individual character that disregards the social determinations that guide the possible care measures.

Phylogenetic analysis of influenza B viruses in Qingdao from 2011 to 2018

Objective To investigate the molecular epidemiological characteristics of hemagglutinin (HA) and neuraminidase (NA) of influenza B viruses (IBV) isolated in Qingdao from 2011 to 2018. Methods A total of 12 236 samples of influenza-like cases in Qingdao from 2011 to 2018 were collected to extract viral RNAs. All samples were screened for influenza A viruses (IAV) and IBV by one-step multiplex real-time RT-PCR. Lineages of IBV were identified. One hundred and eighty-two strains of IBV were selected to amplify HA and NA genes by RT-PCR and then analyzed by sequencing. Phylogenetic analysis and variation analysis of genes and amino acids were carried out. Results IBV was detected almost every year in Qingdao from 2011 to 2018. The positive rate was only slightly lower than that of IAV (4.99% vs 6.21%). B/Victoria linkage had two prominent epidemic years (2011-2012, 2015-2016), while B/Yamagata linkage had three (2013-2014, 2014-2015, 2017-2018). Most of the infected people were children under 10 years old, and the people infected with the two lineages had similar age characteristics. Phylogenetic analysis of HA genes showed clusters in Victoria clades of 1A and 1B and Yamagata clades of 2 and 3. IBV of Yamagata lineage had more amino acid mutation sites than those of Victoria lineage in HA genes with greater genetic diversity. The B/Yamagata strains had 12 amino acid mutations and the B/Victoria strains had seven in four major epitopes. In the receptor binding sites, two amino acid mutations were detected in the B/Yamagata strains and three in the B/Victoria strains. In Qingdao, 26 strains of IBV were intra-lineage reassortments, mostly of the B/Victoria lineage, and 23 strains were inter-lineage reassortments, mostly between HA-B/Yamagata and NA-B/Victoria strains. A possible resistant strain to NA inhibitor was found. Conclusions The significance of IBV in seasonal influenza should not be neglected. Amino acid substitution, insertion/deletion and gene reassortment were the main strategies for the natural evolution of IBV. Influenza surveillance was of great importance and influenza vaccine strains needed to be updated in time. Key words: Influenza B virus; Hemagglutinin (HA) gene; Neuraminidase (NA) gene; Phylogenetic analysis

Epidemiological characteristics of human infection with avian influenza A (H7N9) in Guilin

Objective To analyze the epidemiological characteristics of human infection with H7N9 avian influenza in Guilin in recent years and to provide on-site data and data support for scientific prevention and control of the epidemic of H7N9 avian influenza infection. Methods A descriptive epidemiological method was used to collect the data about human infection with H7N9 avian influenza form three aspects, which were human infection cases in 2017, environmental monitoring for H7N9 avian influenza virus and sentinel surveillance of influenza-like cases. The epidemiological characteristics of human infection with H7N9 avian influenza in Guilin in 2017 were analyzed. Chi-square test was used to compare the positive rates of H7N9 avian influenza virus in environmental specimens. Results A total of six cases of confirmed human H7N9 infection including three deaths were reported in Guilin city in 2017. These cases were from five counties and districts and all occurred in winter and spring. The patients were middle-aged and old men. Most of them were farmers and had a clear history of poultry exposure before the onset of infection. No human H7N9 infection was reported in close contacts or in influenza-like cases. Conclusions H7N9 avian influenza infection in Guilin was characterized by high sporadicity, high incidence in winter and spring, and predominantly middle-aged and elderly men. Avian exposure history was a high risk factor for human infection with H7N9 avian influenza virus. All of the studied cases were severe cases. No human-to-human transmission was reported. Farmers, having a history of poultry slaughter, and underlying diseases were potential risks causing death. Live poultry markets were the main sources of infection, hence closing market could reduce the detection rate of H7N9 avian influenza virus. Strengthen the management of live poultry market and poultry environmental monitoring, closing live poultry markets when viral detection was positive, and suspending live poultry trading were effective measures to control the epidemic of H7N9 avian influenza infection and prevent transmission. Key words: H7N9 avian influenza; Epidemiological characteristics; Prevention and control measures

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.

Genetic characteristics of CV-A12 VP1 region and clinical manifestations of CV-A12-associated severe hand, foot and mouth disease in Qingdao

Objective To investigate the molecular characteristics of coxsackievirus A12 (CV-A12) and to understand the clinical manifestations of severe hand, foot and mouth disease (HFMD) caused by CV-A12 in Qingdao. Methods Throat swabs of HFMD, herpangina and influenza-like cases from 2011 to 2016 were detected for enteroviruses (EVs) in Qingdao. Human rhabdomyosarcoma (RD) and human laryngeal carcinoma (Hep-2) cells were used for virus proliferation and CV-A12 strains were identified through a semi-nest RT-PCR. The full-length of VP1 gene of CV-A12 strains was sequenced and phylogenetically analyzed using MEGA7.0 software package. Clinical data of severe HFMD cases positive for CV-A12 were collected and analyzed. Results CV-A12-positive HFMD, herpangina and influenza-like cases accounted for 0.3%(18/6 798), 1.2%(2/169) and 0.1%(1/676) in Qingdao, respectively. Most of the HFMD caused by CV-A12 in children were mild before 2013 (84.6%, 11/13), while hospitalized severe cases with neurological symptoms (100%, 5/5) became more common after 2013. Phylogenetic analysis of the VP1 region revealed that CV-A12 strains worldwide could be divided into two genotypes, A and B. All of the CV-A12 strains successfully sequenced in Qingdao from 2011 to 2016 belonged to genotype B, and 88.9% (16/18) of them belonged to subgenotype B2. All hospitalized severe cases of CV-A12-caused HFMD after 2013 were associated with strains in branch B2b of subgenotype B2. Conclusion CV-A12 was one of the pathogens causing HFMD, herpangina and influenza-like illness in children in Qingdao. Strains of genotype B2 were the predominant CV-A12 strains circulating in Qingdao in recent years. CV-A12-caused HFMD might complicated by nervous system damage. Key words: Coxsackievirus A12; Severe hand, foot and mouth disease; Phylogenetic analysis

Acute Effects of Air Pollution on Influenza-like Illness in Nanjing, China

Influenza-like illness causes substantial morbidity and mortality. Air pollution has already been linked to many health issues, and increasing evidence in recent years supports an association between air pollution and respiratory infections. It is a pioneer study in China to quantify the effects of air pollution on influenza-like illness. This study used wavelet coherence analysis and generalized additive models to explore the potential association between air pollution (including particulate matter with aerodynamic diameter ≦2.5 μm (PM2.5), particulate matter with aerodynamic diameter ≦10 μm (PM10) and nitrogen dioxide (NO2) and influenza-like illness (a total of 59860 cases) in Nanjing, China from January 1, 2013 to December 31, 2013. The average concentrations of PM2.5, PM10 and NO2 were 77.37 μg/m3, 135.20 μg/m3 and 55.80 μg/m3. An interquartile range increase in PM2.5 concentration was associated with a 2.99% (95% confidence interval (CI): 1.64%, 4.36%) increase in daily influenza-like cases on the same day, while the corresponding increase in NO2 was associated with a 3.77% (95% CI: 2.01%, 5.56%) increase in daily cases. People aged 0-4 were proved to be significantly susceptible to PM10 and NO2; 5-14 ages were significantly susceptible to PM2.5 and PM10; and 15-24 ages were significantly susceptible to all the analyzed air pollutants. Air pollution effects tended to be null or negative for patients aged over 25, which might be due to the small number of influenza-like cases in this age group. This study can be useful for understanding the adverse health effects of air pollution and the cause of influenza-like illness.

Acute effects of air pollution on influenza-like illness in Nanjing, China: A population-based study.

Influenza-like illness causes substantial morbidity and mortality. Air pollution has already been linked to many health issues, and increasing evidence in recent years supports an association between air pollution and respiratory infections. It is a pioneer study in China to quantify the effects of air pollution on influenza-like illness. This study used wavelet coherence analysis and generalized additive models to explore the potential association between air pollution (including particulate matter with aerodynamic diameter ≦2.5 μm (PM2.5), particulate matter with aerodynamic diameter ≦10 μm (PM10) and nitrogen dioxide (NO2)) and influenza-like illness (a total of 59860 cases) in Nanjing, China from January 1, 2013 to December 31, 2013. The average concentrations of PM2.5, PM10 and NO2 were 77.37 μg/m(3), 135.20 μg/m(3) and 55.80 μg/m(3). An interquartile range increase in PM2.5 concentration was associated with a 2.99% (95% confidence interval (CI): 1.64%, 4.36%) increase in daily influenza-like cases on the same day, while the corresponding increase in NO2 was associated with a 3.77% (95% CI: 2.01%, 5.56%) increase in daily cases. People aged 0-4 were proved to be significantly susceptible to PM10 and NO2; 5-14 ages were significantly susceptible to PM2.5 and PM10; and 15-24 ages were significantly susceptible to all the analyzed air pollutants. Air pollution effects tended to be null or negative for patients aged over 25, which might be due to the small number of influenza-like cases in this age group. This study can be useful for understanding the adverse health effects of air pollution and the cause of influenza-like illness.