Local Epidemics Research Articles

Progress in research of 2019-nCoV Omicron variant

2019-nCoV Omicron (B.1.1.529) variant, which has brought new challenges to the prevention and control of COVID-19 pandemic, has the characteristics of stronger transmissibility and more rapid transmission and more significant immune evasion. It took only two months to become a predominant strain worldwide after its identification in South Africa in November 2021. Local epidemics caused by Omicron variant have been reported in several provinces in China. However, the epidemiological characteristics of highly mutated Omicron variant remain unclear. This article summarizes the progress in the research of functional mutations, transmissibility, virulence, immune evasion and cross-reactive immune responses of Omicron variant, to provide references for the effective prevention and control of COVID-19 pandemic caused by Omicron variant.

Epidemiological characteristics of local COVID-19 epidemics and control experience in routine prevention and control phase in China

The COVID-19 pandemic is still ongoing in the world, the risk of COVID-19 spread from other countries or in the country will exist for a long term in China. In the routine prevention and control phase, a number of local COVID-19 epidemics have occurred in China, most COVID-19 cases were sporadic ones, but a few case clusters or outbreaks were reported. Winter and spring were the seasons with high incidences of the epidemics; border and port cities had higher risk for outbreaks. Active surveillance in key populations was an effective way for the early detection of the epidemics. Through a series of comprehensive prevention and control measures, including mass nucleic acid screening, close contact tracing and isolation, classified management of areas and groups at risk, wider social distancing and strict travel management, the local COVID-19 epidemics have been quickly and effectively controlled. The experiences obtained in the control of the local epidemics would benefit the routine prevention and control of COVID-19 in China. The occurrence of a series of COVID-19 case clusters or outbreaks has revealed the weakness or deficiencies in the COVID-19 prevention and control in China, so this paper suggests some measures for the improvement of the future prevention and control of COVID-19.

Bird's Eye View of COVID-19, Mobility, and Labor Market Outcomes Across the US.

COVID-19 dealt a formidable blow to the US economy. We present a joint analysis of the epidemiological and labor market outcomes across US states. We focus on the relationship across relevant indicators in the pre-vaccination era. As expected, we find strong correlation between changes in economic conditions and mobility. However, mobility fluctuations tend to be uncorrelated with local epidemics and occur simultaneously across most states. The magnitude of the mobility response is highly correlated with the rural vs. urban character of the area. Employment losses are most strongly associated with high population density and concentration of the leisure and hospitality industry. The relationship between job losses and the case fatality ratio is affected by the timing of the most severe COVID-19 waves.

Differential Virulence Among Geosmithia morbida Isolates Collected Across the United States Occurrence Range of Thousand Cankers Disease

Thousand cankers disease (TCD), first documented in the western United States in the early 2000s, has spread into nine western and seven eastern states in the United States and northern Italy. TCD incidence and severity differ between eastern and western United States outbreak localities. Black walnut (Juglans nigra) trees, introduced into both urban and plantation settings in the western United States, have been severely impacted as evident by the documented high disease incidence and mortality. However, in eastern United States localities, where J. nigra is native, host-pathogen-vector interactions resulted in two different outcomes: trees either die or partly recover followed by infection. Recent genetic studies on the TCD causal agent, Geosmithia morbida, indicate the spatial genetic structure and high levels of genetic diversity among United States populations. Using detached branch inoculation assays, we reported differential virulence among 25 G. morbida isolates collected across the current distribution range of the disease. As a proxy for virulence, the canker area was measured to 7 days after inoculation. Varying degrees of virulence were observed among tested G. morbida isolates, which was partly explained by their genetic provenance (genetic clusters). Isolates that grouped within genetic cluster 2 (n = 7 from the eastern United States and n = 6 from the western United States; mean = 210.34 mm2) induced significantly larger cankers than isolates that grouped within genetic cluster 1 (n = 12; all western United States isolates; mean = 153.76 mm2). Canker sizes varied among isolates within each genetic cluster and were not correlated with a geographic region (eastern vs. western United States) but rather to the isolated state of origin. Mean canker size also differed in response to isolates that originated from different tree host species. G. morbida isolates collected from Juglans major induced statistically smaller cankers when compared to isolates recovered from undetermined Juglans species but not from J. nigra. In sum, the increased mortality reported for western United States walnut tree populations cannot be explained by a higher virulence of local G. morbida. Plausible explanations for the observed disparity include environmental conditions, such as prolonged drought, greater population densities of walnut twig beetle causing a higher number of inoculation events to individual trees, and multiple introductions of G. morbida originating from multiple locations. Future experimental evaluation should be undertaken to quantify the influence of these factors on the local epidemics.

Luciferase Immunosorbent Assay Based on Multiple E Antigens for the Detection of Chikungunya Virus-Specific IgG Antibodies.

ABSTRACTIn recent years, the chikungunya virus (CHIKV) has continued to spread from local epidemics to nonnative habitats until eventually reaching pandemic status. Nonendemic areas such as China have also emerged as potential epidemic areas of CHIKV. Serological detection of CHIKV is the key to diagnosing and controlling the prevalence of this virus. In this study, we review the progress of the serological detection of the envelope (E) protein in CHIKV, and we provide a novel research assay and ideas for the serological detection of CHIKV. The luciferase immunosorbent assay (LISA) does not require species-specific labeled secondary antibodies for detection, making it universally suitable for tracking samples from various animals or carriers. At present, most research on CHIKV antigen detection technology tends to combine two or more proteins to avoid the decrease in detection ability caused by antigen mutation. Our results indicate that two or more kinds of CHIKV E antigens combined with LISA detection can improve the detection rate of anti-CHIKV immunoglobulin G (IgG) antibodies in CHIKV-infected patient sera and detect antibodies in the early stage of infection accurately and sensitively. After 235 days of infection, the anti-CHIKV IgG antibodies could still be detected in CHIKV-infected patients. All serum samples were tested with a detection rate of 100% after combining various recombinant CHIKV E antigens. Our proposed CHIKV-specific LISA could be a useful tool for serum diagnosis of CHIKV infection and serum epidemic research in areas where CHIKV is endemic, which would help to manage potential epidemics in the future.IMPORTANCE At present, chikungunya virus (CHIKV) is still circulating in some parts of the world, and mutated strains have emerged, making it easier for the virus to spread among humans. With the continuous variation of CHIKV, its antigen variation leads to the decline of detection ability. In addition, the risk of transmission of CHIKV in areas where CHIKV is not endemic, such as China, has increased dramatically, which compels us to enhance the detection capacity of CHIKV and continuously monitor CHIKV antibody levels in the population. Real-time quantitative PCR (RT-PCR) detection technology will not be reliable when the infection time is chronic or in subclinical infection due to decreases in virus concentration, and an antibody detection technology must be adopted. In this study, multiple CHIKV envelope (E) antigens were used to detect anti-CHIKV IgG antibodies in serum for the first time. The new assay is characterized by convenient operation, high detection rate, and high sensitivity and has significance for early warning and monitoring. Moreover, it contributes to the prevention and control of CHIKV.

Similar But Different: Integrated Phylogenetic Analysis of Austrian and Swiss HIV-1 Sequences Reveal Differences in Transmission Patterns of the Local HIV-1 Epidemics.

Phylogenetic analyses of 2 or more countries allow to detect differences in transmission dynamics of local HIV-1 epidemics beyond differences in demographic characteristics. A maximum-likelihood phylogenetic tree was built using pol -sequences of the Swiss HIV Cohort Study (SHCS) and the Austrian HIV Cohort Study (AHIVCOS), with international background sequences. Three types of phylogenetic cherries (clusters of size 2) were analyzed further: (1) domestic cherries; (2) international cherries; and (3) SHCS/AHIVCOS-cherries. Transmission group and ethnicities observed within the cherries were compared with the respective distribution expected from a random distribution of patients on the phylogeny. The demographic characteristics of the AHIVCOS (included patients: 3'141) and the SHCS (included patients: 12'902) are very similar. In the AHIVCOS, 36.5% of the patients were in domestic cherries, 8.3% in international cherries, and 7.0% in SHCS/AHIVCOS cherries. Similarly, in the SHCS, 43.0% of the patients were in domestic cherries, 8.2% in international cherries, and 1.7% in SHCS/AHIVCOS cherries. Although international cherries in the SHCS were dominated by heterosexuals with men who have sex with men being underrepresented, the opposite was the case for the AHIVCOS. In both cohorts, cherries with one patient belonging to the transmission group intravenous drug user and the other one non-intravenous drug user were underrepresented. In both cohorts, international HIV transmission plays a major role in the local epidemics, mostly driven by men who have sex with men in the AHIVOS, and by heterosexuals in the SHCS, highlighting the importance of international collaborations to understand global HIV transmission links on the way to eliminate HIV.

The SARS-CoV-2 pandemic in Germany may represent the sum of a large number of local but independent epidemics each initiated by individuals aged 10-19 years, middle-aged males, or elderly individuals.

Many epidemiological aspects of the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) pandemics, particularly those affecting children, are still sparsely elucidated. Data on the first pandemic phase during the year 2020 indicated that children might serve as a virus reservoir. We now analyzed data on more than 530 000 SARS‐CoV‐2 polymerase chain reaction (PCR) and 12 503 anti‐SARS‐CoV‐2 antibody tests performed in the west of Germany until Week 4 of 2021. We show that children of at least 10 years of age may play a prominent role in the pandemic showing highest PCR‐positive rates in the first (Weeks 28–35), second (Weeks 42–48), and third wave (Week 50 of 2020–Week 2 2021) of the second pandemic phase, although the waves were not mainly initiated by children. The waves' kinetics differed even in nearby cities. Low PCR‐positive rates were confined to areas of lower population density. PCR‐positive rates were higher among middle‐aged males compared with women and among very old females compared with males. From Week 25, seroprevalence rates slowly increased to 50%, indicating ongoing virus activity. In conclusion, the SARS‐CoV‐2 pandemics is characterized by many local but interacting epidemics, initiated and driven by different social groups. Children may not be the main initiators of virus spreading but older children may significantly affect the course of the pandemic. High population density is associated with higher SARS‐CoV‐2 incidence.

Public health governance on the Brazil-Bolivia border: what the pandemic teaches us?

The purpose of this article is to present and reaffirm the importance of shared public health management on the Brazil-Bolivia border. To this end, bibliographic and documentary surveys were carried out, as well as interviews with 14 experts who form the Community of Inquiry, an investigation method developed by John Dewey that provides a useful lens for studies on shared management, as it emphasizes the plurality of actors beyond the actions of the State, demonstrating how public health problems are dealt with in the region. Specifically, we detail part of COVID-19's first operations (February to June 2020) in the municipalities of Corumbá and Ladário (Brazil) and Puerto Quijarro and Puerto Suarez (Bolivia). Recognizing the political dimension of the problematic situation, we rekindle the importance of governance for combating the COVID-19 pandemic and for the shared management of other urgent local epidemics, such as dengue and H1N1 on the border.

Incorporating temporal distribution of population-level viral load enables real-time estimation of COVID-19 transmission

Many locations around the world have used real-time estimates of the time-varying effective reproductive number ({R}_{t}) of COVID-19 to provide evidence of transmission intensity to inform control strategies. Estimates of {R}_{t} are typically based on statistical models applied to case counts and typically suffer lags of more than a week because of the latent period and reporting delays. Noting that viral loads tend to decline over time since illness onset, analysis of the distribution of viral loads among confirmed cases can provide insights into epidemic trajectory. Here, we analyzed viral load data on confirmed cases during two local epidemics in Hong Kong, identifying a strong correlation between temporal changes in the distribution of viral loads (measured by RT-qPCR cycle threshold values) and estimates of {R}_{t} based on case counts. We demonstrate that cycle threshold values could be used to improve real-time {R}_{t} estimation, enabling more timely tracking of epidemic dynamics.

Savannah's Midnight Hour: Boosterism, Growth, and Commerce in a Nineteenth-Century American City

In Lisa L. Denmark's telling, the midnight hour for Savannah, Georgia, came not in a garden but in a self-inflicted financial crisis in 1877, when the city government defaulted on its municipal debt. This is an urban history without describing the organic growth of neighborhoods or communities. Instead, Denmark focuses on municipal finance, investment strategies in transportation projects by city government intended to reduce future taxation and to extend Savannah's commercial control of its economic hinterlands, and the politics by which differing elites won control of the municipal corporation of the city. Principally a financial history, the story is filled with interesting descriptions of tax revenue and taxpayer revolts, bond issues and refinancing schemes, corporate boards and stockholder elections, and the successes and failures of steamship lines, canal enterprises, railroads, harbor dredging, swamp draining, and sewer construction. Interspersed are tales of municipal elections, national depressions, and local epidemics. Denmark's goal...

ERxNet: A Pipeline of Convolutional Neural Networks for Tuberculosis Screening

Tuberculosis (TB) is a contagious disease affecting millions of people annually worldwide. Treatment of this disease and reduction in local epidemics can be improved markedly by increasing the speed and efficiency of screening and diagnosis. eRxNet is a pipeline of convolutional neural networks designed to provide healthcare professionals with detailed and accurate analysis of chest X-rays (CXRs) for TB screening. The pipeline combines whole image classification, object detection (bounding boxes), and instance segmentation (polygonal masks) to provide data analysis at varying levels of detail. In order to construct a high performing system, a comparison of different CNN architectures applied to these tasks is presented. Images from two large TB datasets, UML-Peru and TBX11K, were used for training and evaluation of the models. Combining the two datasets required the development of a preprocessing stage which includes lung segmentation and image enhancement. We show that the resulting four-stage pipeline of CNNs, using a combination of DenseNet, Faster R-CNN, and Mask R-CNN, has sufficiently strong performance to be a useful tool for TB screening.

Persistence of SARS-CoV-2 RNA in wastewater after the end of the COVID-19 epidemics

Although the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been widely detected in wastewater in many countries to track the COVID-19 pandemic development, it is still a lack of clear understanding of the persistence of SARS-CoV-2 in raw sewage, especially after the end of the COVID-19 pandemic event. To fill this knowledge gap, this study conducted a field trial on the SARS-CoV-2 presence in various wastewater facilities after the end of the COVID-19 epidemics in Beijing. The result showed that the wastewater treatment facility is a large SARS-CoV-2 repository. The viral RNA was still present in hospital sewage for 15 days and was continually detected in municipal WWTPs for more than 19 days after the end of the local COVID-19 epidemics. The T90 values of the SARS-CoV-2 RNA in raw wastewater were 17.17–8.42 days in the wastewater at 4 ℃ and 26 ℃, respectively, meaning that the decay rates of low titer viruses in raw sewage were much faster. The results confirmed that the SARS-CoV-2 RNA could persist in wastewater for more than two weeks, especially at lower temperatures. The sewage systems would be a virus repository and prolong the presence of the residual SARS-CoV-2 RNA. The study could enhance further understanding of the presence of SARS-CoV-2 RNA in raw wastewater.

Capacity Building for Vaccine Manufacturing Across Developing Countries: The Way Forward

ABSTRACT Approved vaccines prevent 2 to 3 million deaths per year. There is a lack of equitable access to vaccines in the low- and middle-income developing nations. Challenges in the life cycle of vaccine production include process development, lead time, intellectual property, and local vaccine production. A robust and stable manufacturing process and constant raw material supplies over decades is critical. In a continuously evolving vaccine landscape, the need of the hour for developing nations is to manufacture their own vaccines besides having supply security, control over production scheduling and sustainability, control of costs, socio-economic development, and rapid response to local epidemics. There is a need for capacity building of workforce development, technology transfer, and financial support. Technology transfer has improved vaccine access and reduced prices of vaccines. Capacity building for the manufacturing of vaccines in developing countries has always been an area of paramount importance and more so in a pandemic situation.

Biscogniauxia Charcoal Canker—A New Potential Threat for Mid-European Forests as an Effect of Climate Change

Biscogniauxia nummularia (Bull.) Kuntze is a fungus which induces strip-cankers on beech, commonly referred to as charcoal canker. The symptoms of infection are visible on the host tree’s bark as elongated, blackish bark lesions on the trunk and branches. Recent years have shown that, due to climate change causing local epidemics, the species is increasing its economic impact in Mediterranean regions. Until recently, B. nummularia was considered rare and uncommon in central Europe. However, in the last few years it has been noticed more often, mostly in coniferous trees, which are out of B. nummularia’s host range. A similar situation has been observed with the closely related species Biscogniauxia mediterranea (De Not.) Kuntze, which prior to 2017 had not been observed in central Europe at all. This study shows the genetic diversity of mid-European strains of Biscogniauxia spp. (based on the ITS, TEF1, TUB2 and ACT regions) and, as the first in Europe, presents a molecular investigation of this species isolated from coniferous trees. It is also the first attempt at estimating the potential impact of this pathogenic fungus on European forestry management in the close future.

Epidemije u Srbiji tokom ratova 1912-1918. - prilog kvantifikaciji žrtava

The aim of this paper is to point out the part of different epidemics in the reduction of population in Serbia during the First and Second Balkan Wars (1912 - 1913) and the First World War (1914 - 1918). In addition to suffering on the battlefield, the war conditions of life also led to the culmination of various diseases and the appearance of various major and minor, local, regional and world epidemics. By comparing data from the 1910-1913 census and in 1921 there was a population reduction of 526,430. (4,393,315: 3,866,885). Various infectious diseases took significantly more lives than all other causes combined, including war. According to accepted estimates, during the war years, infectious diseases took about 360,000 lives. The typhus epidemic, which affected the whole of Serbia during the first half of 1915, took about 135,000 lives. This paper is largely based on the analysis of church registers of the dead, and it points out several different local epidemics that affected the Serbian army and civilian population during the war years with great mortal consequences which took about 110,000 lives. These epidemics appeared during the all war years, associated or not associated with each other, and in different territories. These epidemics were: cholera, smallpox, diphtheria, dysentery, scarlet fever, whooping cough, etc.

A Limited Spreading Event of COVID-19 Caused by Delta Variant in a Cosmetic Hospital - Yantai City, Shandong Province, China, 2021.

What is already known about this topic?Coronavirus disease 2019 (COVID-19) outbreaks in the past were mostly caused by overseas transmission, but if control measures are not appropriately applied, domestic transmission could also cause large-scale local epidemics.What is added by this report?This report covers all information of epidemic investigation processes, epidemiological characteristics and exposure history, transmission chains, sequencing results as well as public health measures taken for the COVID-19 cluster epidemic caused by the Delta variant in a cosmetic hospital in Yantai City in August 2021.What are the implications for public health practice?The information provided in this report, including active case finding, community management, and mass testing, may assist public health professionals in dealing with local COVID-19 epidemics caused by domestic transmission.

Use of Sanger protocols to identify variants of concern, key mutations and track evolution of SARS-CoV-2

Vaccination and the emergence of SARS-CoV-2 variants mark the second year of the pandemic. Variants have amino acid mutations at the spike region, a viral protein central in the understanding of COVID-19 pathogenesis and vaccine response. Variants may dominate local epidemics, as Gamma (P.1) in Brazil, emerging in 2020 and prevailing until mid-2021. Different obstacles hinder a wider use of Next-Generation Sequencing for genomic surveillance. We describe Sanger based sequencing protocols: i) Semi-nested RT-PCR covering up to 3.684 kb (>96 %) spike gene; ii) One-Step RT-PCR for key Receptor Binding Domain (RBD) mutations (codons 417–501); iii) One-Step RT-PCR of partial N region to improve genomic capability. Protocols use leftovers of RNA extracted from nasopharyngeal swabs for quantitative RT-PCR diagnosis; with retro-transcribed DNA sequenced at ABI 3500 using dye termination chemistry. Analyses of sequences from 95 individuals (late 2020/early 2021) identified extensive amino acid variation, 57 % with at least one key mutation at the Receptor Binding Domain, with B.1.1.28 lineage most prevalent, followed by Gamma and Zeta variants, with no Delta variant observed. The relatively low cost and simplicity may provide an accessible tool to improve surveillance of SARS-CoV-2 evolution, monitor new variants and vaccinated breakthroughs.

Epidemiological characteristics of three local epidemics of COVID-19 in Guangzhou

Objective: To understand the epidemiological characteristics of three local COVID-19 epidemics in Guangzhou and provide reference for optimizing strategies and measures of COVID-19 prevention and control. Methods: The data of local COVID-19 cases in Guangzhou reported as of June 18, 2021 were collected from National Notifiable Disease Report System of China. The software Excel 2019 and SPSS 22.0 were applied for data cleaning and statistical analysis. Results: A total of 726 COVID-19 cases were reported in the three local epidemics in Guangzhou. In the epidemic associated with the outbreak of COVID-19 in Hubei province, 366 cases were reported. Most cases were female (51.6%, 189/366), aged 18-65 years (81.4%, 298/366), jobless/unemployed (32.2%, 118/366) and retired persons (20.2%,74/366). The initial symptoms of most cases were fever (71.6%, 250/349) and cough (60.7%, 212/349). In the epidemic associated with the imported COVID-19 cases from Africa, 207 cases were reported. Most cases were aged 18-40 years (72.9%, 151/207), male (69.6%, 144/207), and engaged in commercial services (62.3%,129/207). The initial symptoms of most cases were no obvious discomfort (55.6%, 15/27) and cough (37.0%, 10/27). In the epidemic associated with Delta variant of SARS-CoV-2, 153 cases were reported, in which women accounted for 58.8% (90/153), most cases were over 41 years old (64.7%,99/153), and retired persons accounted for the highest proportion (32.0%,49/153). The initial symptoms of most cases were cough (32.9%, 48/146) and no obvious discomfort (28.1%, 41/146). The household secondary attack rates of the three local epidemics were 11.2%, 5.7% and 11.5%, respectively. The median (P25, P75) of incubation periods were 6.5 (4.0,10.8) d, 4.0 (2.5, 6.0) d and 4.0 (3.0,5.0) d. The serial intervals median (P25, P75) were 4.0 (3.0, 8.0) d, 4.0 (2.5, 6.0) d and 3.0 (2.0,5.0) d. There were significant differences in gender, age, occupation, initial symptoms, household secondary attack rate and incubation period among the three local COVID-19 epidemics (all P<0.05). In the proportion of the case finding way, passive detection in patient treatment were mainly 44.3%(162/366) in the epidemic associated with the outbreak of COVID-19 in Hubei province,but active community case screening [58.5% (121/207) and 27.5% (24/153)] and close contact management in imported case were mostly [33.3% (69/207) and 67.3% (103/153)] in the epidemic associated with the imported COVID-19 cases from Africa and with Delta variant of SARS-CoV-2, respectively. Conclusions: Due to the different sources of infection, strain types and prevention and control strategies, the epidemiological characteristics of the three local COVID-19 epidemics in Guangzhou differed in demographics, clinical symptoms, transmission routes and case finding, which suggested that it is necessary to improve the key population and common symptom monitoring in the routine prevention and control of COVID-19 to prevent the reemerge of the epidemic.

Metagenomics combined with comprehensive validation as a public health risk assessment tool for urban and agricultural run-off

Early detection of emerging and life-threatening pathogens circulating in complex environments is urgently required to combat infectious diseases. This study proposed a public health risk assessment workflow with three stages, pathogen screening, pathogen genotyping, and risk assessment. In stage one, pathogens were screened with metagenomic sequencing, microfluidic chip, and qPCR. In stage two, pathogens were isolated and genotyped with multi-locus sequence typing (MLST) or conventional PCR. Finally, virulence genes from metagenomic data were assessed for pathogenicity. Two regions (Donggang and Zhanjiang) with potential public health concerns were selected for evaluation, each of which comprised of one urban and one farming wastewater sampling location. Overall, metagenomic sequencing reflected the variation in the relative abundance of medically important bacteria. Over 90 bacterial pathogens were monitored in the metagenomic dataset, of which 56 species harbored virulence genes. In Donggang, a pathogenic Acinetobacter sp. reached high abundances in 2018 and 2020, whereas all pathogenic Vibrio spp. peaked in October 2019. In Zhanjiang, A. baumanni, and other Enterobacteriaceae species were abundantly present in 2019 and 2020, whereas Aeromonas and Vibrio spp. peaked in November-2017. Forty species were subsequently isolated and subtyped by MLST, half of which were prevalent genotypes in clinical data. Additionally, we identified the African Swine Fever Virus (ASFV) in water samples collected in 2017, ahead of the first reported ASFV outbreak in 2018 in China. RNA viruses like Hepatitis A virus (HAV) and Enterovirus 71 (EV71) were also detected, with concentrations peaking in April 2020 and April 2018, respectively. The dynamics of HAV and EV71 were consistent with local epidemic trends. Finally, based on the virulence gene profiles, our study identified the risk level in wastewater of two cities. This workflow illustrates the potential for an early warning of local epidemics, which helps to prioritize the preparedness for specific pathogens locally.

Antiviral Treatments for Influenza.

Influenza is an acute respiratory illness caused by the influenza A, B, and C viruses. It can occur in local outbreaks or seasonal epidemics, with possibility to spread worldwide in a pandemic when a novel strain with significant antigenic differences emerges. During the past years, several new drugs have become available, with different accessibility related to specific countries' approval. We have conducted a review of literature, analyzing the most recent data on efficacy and safety of drugs currently available to treat influenza, with a particular attention toward special populations. Efficacy and safety profile of neuraminidase inhibitors (oseltamivir, zanamivir, laninamivir, peramivir) and recently approved cap-dependent endonuclease inhibitor baloxavir marboxil are reported in literature, but still little information is available about special populations such as critically ill patients and patients with a history of chronic respiratory disease. Moreover, the emergence of strains with reduced or no susceptibility to current drugs is a matter of concern, suggesting the need of constant monitoring of viral variants.