RESUMEN

Introducción. Durante 2020 y 2021, la circulación de los virus influenza se mantuvo por debajo de lo esperado en todo el mundo. En Argentina, en el año 2022 observamos una circulación ininterrumpida de influenza todo el año. Nuestros objetivos fueron describir los patrones de circulación y las características clínicas de niños internados con influenza. Población y métodos. Estudio retrospectivo, analítico, observacional. Se incluyeron todos los niños internados en un centro pediátrico con detección del virus influenza durante los años 2019-2022. Resultados. Se internaron 138 pacientes en 4 años; en 2019 se observó una tasa del 4,5/1000 egresos hospitalarios mientras que en 2022, fue del 15,1/1000. En 2020 y 2021 no hubo casos. En el 2019 la mayoría de los casos ocurrieron en invierno, la causa de la internación fue la infección respiratoria aguda baja (IRAB) en el 79 % y se detectó influenza A en el 92 % de los casos. En el 2022, la mayoría de los casos ocurrieron en primavera, el 62 % presentó IRAB y en el 56 % se detectó influenza A. Ambos períodos tuvieron similares frecuencias de vacunación y de comorbilidades. Conclusiones. En el 2022 se registraron más internaciones por influenza, lo que podría corresponder a que se realizaron métodos diagnósticos moleculares, que son más sensibles, y se observó un cambio en la estacionalidad con más casos en primavera. En 2019 predominó influenza A en infecciones del tracto respiratorio inferior, mientras que en el 2022 influenza A y B fueron similares, y hubo más formas extrapulmonares.

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Introduction. During 2020 and 2021, the circulation of influenza virus remained below expectations worldwide. In Argentina, in 2022, we observed an uninterrupted circulation of influenza all year round. Our objectives were to describe the circulation patterns and clinical characteristics of hospitalized children with influenza. Population and methods. Retrospective, analytical, observational study. All children with influenza virus admitted to a children's hospital during the 2019­2022 period were included. Results. A total of 138 patients were admitted over 4 years; in 2019, the rate of hospital discharges was 4.5/1000, compared to 15.1/1000 in 2022. No cases were recorded in 2020 and 2021. In 2019, most cases were observed in the winter; in 79%, the cause was acute lower respiratory tract infection (ALRTI); influenza A was detected in 92%. In 2022, most cases occurred in the spring; 62% developed ALRTI; and influenza A was detected in 56%. Similar rates of vaccination and comorbidities were observed in both periods. Conclusions. In 2022, more hospitalizations due to influenza were recorded, which may have correlated with the use of more sensitive molecular diagnostic testing and a change in seasonality, with more cases observed in the spring. In 2019, influenza A predominated in lower respiratory tract infections, while in 2022, cases of influenza A and B were similar, with more extra-pulmonary forms.

Asunto(s)

Humanos , Preescolar , Niño , Infecciones del Sistema Respiratorio/epidemiología , Gripe Humana/diagnóstico , Gripe Humana/epidemiología , COVID-19/diagnóstico , COVID-19/epidemiología , Argentina/epidemiología , Estudios Retrospectivos , Pandemias , Hospitalización , Hospitales

RESUMEN

Introduction. During 2020 and 2021, the circulation of influenza virus remained below expectations worldwide. In Argentina, in 2022, we observed an uninterrupted circulation of influenza all year round. Our objectives were to describe the circulation patterns and clinical characteristics of hospitalized children with influenza. Population and methods. Retrospective, analytical, observational study. All children with influenza virus admitted to a children's hospital during the 2019-2022 period were included. Results. A total of 138 patients were admitted over 4 years; in 2019, the rate of hospital discharges was 4.5/1000, compared to 15.1/1000 in 2022. No cases were recorded in 2020 and 2021. In 2019, most cases were observed in the winter; in 79%, the cause was acute lower respiratory tract infection (ALRTI); influenza A was detected in 92%. In 2022, most cases occurred in the spring; 62% developed ALRTI; and influenza A was detected in 56%. Similar rates of vaccination and comorbidities were observed in both periods. Conclusions. In 2022, more hospitalizations due to influenza were recorded, which may have correlated with the use of more sensitive molecular diagnostic testing and a change in seasonality, with more cases observed in the spring. In 2019, influenza A predominated in lower respiratory tract infections, while in 2022, cases of influenza A and B were similar, with more extra-pulmonary forms.

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Introducción. Durante 2020 y 2021, la circulación de los virus influenza se mantuvo por debajo de lo esperado en todo el mundo. En Argentina, en el año 2022 observamos una circulación ininterrumpida de influenza todo el año. Nuestros objetivos fueron describir los patrones de circulación y las características clínicas de niños internados con influenza. Población y métodos. Estudio retrospectivo, analítico, observacional. Se incluyeron todos los niños internados en un centro pediátrico con detección del virus influenza durante los años 2019-2022. Resultados. Se internaron 138 pacientes en 4 años; en 2019 se observó una tasa del 4,5/1000 egresos hospitalarios mientras que en 2022, fue del 15,1/1000. En 2020 y 2021 no hubo casos. En el 2019 la mayoría de los casos ocurrieron en invierno, la causa de la internación fue la infeccción respiratoria aguda baja (IRAB) en el 79 % y se detectó influenza A en el 92 % de los casos. En el 2022, la mayoría de los casos ocurrieron en primavera, el 62 % presentó IRAB y en el 56 % se detectó influenza A. Ambos períodos tuvieron similares frecuencias de vacunación y de comorbilidades. Conclusiones. En el 2022 se registraron más internaciones por influenza, lo que podría corresponder a que se realizaron métodos diagnósticos moleculares, que son más sensibles, y se observó un cambio en la estacionalidad con más casos en primavera. En 2019 predominó influenza A en infecciones del tracto respiratorio inferior, mientras que en el 2022 influenza A y B fueron similares, y hubo más formas extrapulmonares.

Asunto(s)

COVID-19 , Gripe Humana , Infecciones del Sistema Respiratorio , Niño , Humanos , Lactante , Gripe Humana/diagnóstico , Gripe Humana/epidemiología , Estudios Retrospectivos , Argentina/epidemiología , Pandemias , COVID-19/diagnóstico , COVID-19/epidemiología , Hospitalización , Infecciones del Sistema Respiratorio/epidemiología , Hospitales

RESUMEN

Lower respiratory tract infections (LRIs) are a significant cause of disability-adjusted life-years (DALYs) across all age groups, especially in children under 9 years of age, and adults over 75. The main causative agents are viruses, such as influenza and respiratory syncytial virus (RSV). Viral LRIs in adults have historically received less attention. This study investigated the incidence of RSV and influenza in adult patients admitted to a referral hospital, as well as the clinical profile of these infections. Molecular testing was conducted on nasopharyngeal samples taken from a respiratory surveillance cohort comprising adult (15-59 years) and elderly (60+ years) hospitalized patients who tested negative for SARS-CoV-2, to determine the prevalence for influenza and RSV. Influenza was found to be less frequent among the elderly. The main symptoms of RSV infections were cough, fever, dyspnea, malaise, and respiratory distress, while headache, nasal congestion, a sore throat, and myalgia were most frequent in influenza. Elderly patients with RSV were not found to have more severe illness than adults under age 60, underscoring the importance of providing the same care to adults with this viral infection.

Asunto(s)

COVID-19 , Gripe Humana , Infecciones por Virus Sincitial Respiratorio , Virus Sincitial Respiratorio Humano , Niño , Anciano , Adulto , Humanos , Persona de Mediana Edad , Infecciones por Virus Sincitial Respiratorio/epidemiología , Enfermedades Desatendidas , Gripe Humana/epidemiología , SARS-CoV-2

RESUMEN

Introdução: A Influenza é uma doença respiratória altamente contagiosa, prevenível por vacinação, afetando todos os grupos etários,com morbidade e mortalidade variáveis. O objetivo deste estudo foi analisar a relação da situação vacinal dos pacientes com Influenza A/B atendidos com Síndrome Respiratória Aguda Grave. Métodos: Estudo retrospectivo, a partir das notificações do Sistema de Informação de Agravos de Notificação Compulsório do Brasil, de pacientes com esquema vacinal conhecido para Influenza A/B em um hospital-escola do interior do Rio Grande do Sul (2012 a 2018). Resultados: Foram incluídos 596 casos de SRAG, sendo 179 (30,0%) por vírus respiratórios [92 (51,4%) Influenza A/B e 87 (48,6%) outros vírus respiratórios]. Na faixa etária de maiores de 50 anos, a frequência foi 28,2%, 6 meses a 1 ano foi de 19,6%, seguido de 13% no grupo etário de 2 a 4 anos. O esquema vacinal estava completo em 59,8% dos casos, sendo que em 37,5% dos pacientes apresentavam esquema vacinal incompleto. O tratamento antiviral foi administrado em 90,2% do pacientes com SRAG por Influenza A/B, e a alta hospitalar ocorreu em 91,3% dos casos. Conclusão: A vacinação é uma estratégia para prevenção de complicações relacionadas à Influenza. No entanto, a SRAG é uma apresentação com diagnóstico diferencial amplo, e as causas virais necessitam de confirmação para uma otimização da terapêutica antiviral. A equipe de saúde deve estar atenta a pacientes com riscos de SRAG, a fim de minimizar os desfechos negativos, mesmo nos vacinados.

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Introduction: Influenza is a highly contagious respiratory disease, preventable by vaccination, affecting all age groups, with variable morbidity and mortality. The objective of this study was to analyze the relationship between the vaccination status of Influenza A/B patients seen with Severe Acute Respiratory Syndrome. Methods: Retrospective study, from notifications of the Brazilian Compulsory Notification Agencies Information System (Sistema de Informação de Agravos de Notificação Compulsório do Brasil), of patients with known vaccination schemes for Influenza A/B in a teaching hospital in the interior of Rio Grande do Sul (2012 to 2018). Results: Of the 596 cases of SARS included, 179 (30.0%) were due to respiratory viruses [92 (51.4%) Influenza A/B and 87 (48.6%) other respiratory viruses]. In the age group over 50 years, the frequency was 28.2%, from 6 months to 1 year old was 19.6%, followed by 13% in the age group of 2 to 4 years. The vaccination schedule was complete in 59.8% of cases, with 37.5% having an incomplete vaccination scheme. Antiviral treatment was administered in 90.2% of the patients with SARS by Influenza A/B, and hospital discharge occurred in 91.3% of the cases. Conclusion: Vaccination is a strategy to prevent complications related to Influenza. However, SARS is a presentation with wide differential diagnosis, and the viral causes need confirmation for an optimization of the antiviral therapy. The healthcare team must be aware of patients at risk of SARS to minimize negative outcomes, even in vaccinated patients.

Asunto(s)

Enfermedades Respiratorias , Gripe Humana

RESUMEN

RESUMEN En el Perú, la pandemia de la COVID-19 ha evidenciado la utilidad de tener un sistema de vigilancia laboratorial estructurado y en funcionamiento desde hace 22 años, basado en la vigilancia de influenza; inicialmente en modalidad de unidades centinela, y después fortaleciéndose e innovándose, con recursos propios y con apoyo externo, para generar información de calidad. Se han implementado avances biotecnológicos para la confirmación diagnóstica e incrementado las capacidades de la red nacional de laboratorios, manteniendo la eficiencia, considerando las diversas y complejas realidades de los niveles regionales, y superando dificultades de comunicación y articulación entre instituciones. Resulta necesario consolidar este sistema, con trabajo colaborativo y coordinado entre sus componentes, impulsando su eficacia y oportunidad y promoviendo la vigilancia genómica de nuevos virus y variantes, como actualmente ocurre con el SARS-CoV-2.

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ABSTRACT In Peru, the COVID-19 pandemic demonstrated the usefulness of having a structured laboratory surveillance system that has been operational for 22 years, based on influenza surveillance; initially in the form of sentinel units, and later strengthened and innovated, with its own resources and with external support, to provide quality information. Biotechnological advances have been implemented for diagnostic confirmation and the capacity of the national laboratory network has been expanded, maintaining efficiency, considering the diverse and complex realities of each region, and overcoming difficulties regarding communication and articulation between institutions. It is necessary to consolidate this system, with collaborative and coordinated work between its components, boosting its effectiveness and timeliness and promoting genomic surveillance of new viruses and variants, as is currently the case with SARS-CoV-2.

Asunto(s)

Virus , Servicios de Vigilancia Epidemiológica , Vigilancia en Salud Pública , SARS-CoV-2 , Virus de la Influenza A , Virus de la Influenza B , Vigilancia Sanitaria , Técnicas de Diagnóstico Molecular , Servicios Laboratoriales de Salud Publica , Sistemas Nacionales de Salud , Monitoreo Epidemiológico , Prueba de COVID-19

RESUMEN

Resumen La miocarditis es una inflamación del miocardio causada principalmente por infecciones virales, dentro de las cuales se encuentra el virus Influenza tipo B. Su presentación clínica varía desde individuos asintomáticos o con síntomas leves e inespecíficos a una miocarditis fulminante e incluso muerte súbita. La principal consecuencia a largo plazo es una miocardiopatía dilatada con insuficiencia cardiaca. Se presenta el caso de una femenina de 17 años, sin patologías crónicas conocidas, la cual presentó un cuadro viral de dos días de evolución y luego falleció de manera súbita; en la autopsia médico legal se documentó mediante estudios histopatológicos una miocarditis linfocítica aguda y por medio de la técnica de reacción en cadena de la polimerasa (PCR) de un frotis traqueal se evidenció la presencia del virus influenza tipo B. Se realizó una revisión de la literatura sobre miocarditis principalmente miocarditis viral causada por el virus Influenza B.

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Abstract Myocarditis is an inflammatory disease of the heart muscle. Viral infections are the most frequent cause of myocarditis, incluided Influenza B virus. The clinical presentation of acute miocarditis is highly variable, ranging from subclinical disease to fulminant heart failure and sometimes with sudden death. The major long term consequence is dilated cardiomyopathy with chronic heart failure. We present a case of a 17 years old woman who presented with viral symptoms for two days and then died suddenly; in the medico-legal autopsy, an acute lymphocytic myocarditis was documented through histopathological studies and the presence of influenza type B virus was evidenced by means of the polymerase chain reaction (PCR) technique of a tracheal smear. A review of the literature on myocarditis, mainly viral miocarditis caused by the Influenza B virus, was made.

Asunto(s)

Humanos , Femenino , Adolescente , Virus de la Influenza B , Miocarditis/patología , Costa Rica

RESUMEN

RESUMO Apresentação de um caso de infecção por Influenza B e doença de Kawasaki em adolescente ocorrido durante a pandemia da COVID-19. Adolescente asmática evoluiu com febre e síndrome gripal por 7 dias e deu entrada com quadro de insuficiência respiratória aguda, necessitando de intubação orotraqueal. Evoluiu também com instabilidade hemodinâmica respondedora ao uso de droga vasoativa. Foram introduzidas antibioticoterapia e medidas de suporte. Apresentou melhora hemodinâmica e respiratória progressiva, porém mantinha febre e alteração de provas inflamatórias. Durante internação, evoluiu com conjuntivite não purulenta bilateral, descamação de mão e pés, língua em framboesa e linfonodomegalia cervical, recebendo diagnóstico de doença de Kawasaki. Recebeu gamaglobulina e, por conta de quadro clínico refratário, foi administrado também corticoide, evoluindo afebril 24 horas após. Não apresentou alterações coronarianas. O único agente isolado foi Influenza B, mesmo realizando painel viral e investigação para COVID-19 com reação em cadeia da polimerase e sorologia. Durante internação, apresentou tromboembolismo pulmonar, e, em investigação de coagulopatias, foi diagnosticada com mutação em heterozigose de fator V de Leiden. Há uma potencial associação entre doença de Kawasaki e infecção por Influenza B ou outros vírus, como o coronavírus e, por isso, esses diagnósticos devem ser investigados nos pacientes pediátricos, incluindo adolescentes, com quadros febris prolongados.

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ABSTRACT We report a case of Influenza B infection and Kawasaki disease in an adolescent, diagnosed during the COVID-19 pandemic. An asthmatic female adolescent presented with fever and flu-like symptoms for 7 days and was admitted with acute respiratory failure requiring mechanical ventilation. She progressed with hemodynamic instability responsive to vasoactive drugs. Antibiotic therapy and support measures were introduced, showing progressive hemodynamics and respiratory improvement, however with persistent fever and increased inflammatory markers. During the hospitalization, she developed bilateral non-purulent conjunctivitis, hand and feet desquamation, strawberry tongue, and cervical adenopathy, and was diagnosed with Kawasaki disease. She was prescribed intravenous immunoglobulin and, due to the refractory clinical conditions, corticosteroid therapy was added; 24 hours later, the patient was afebrile. No coronary changes were found. A full viral panel including COVID-19 C-reactive protein and serology could only isolate the Influenza B virus. During the hospitalization, she was diagnosed with pulmonary thromboembolism; coagulopathies were investigated, and she was diagnosed with heterozygous factor V Leiden mutation. There is a potential association between Kawasaki disease and infection with Influenza B or with other viruses such as coronavirus. Therefore, this association should be considered in pediatric patients, adolescents included, with prolonged febrile conditions.

Asunto(s)

Humanos , Femenino , Adolescente , Insuficiencia Respiratoria/diagnóstico , Gripe Humana/diagnóstico , COVID-19 , Síndrome Mucocutáneo Linfonodular/diagnóstico , Virus de la Influenza B/aislamiento & purificación , Respiración Artificial , Insuficiencia Respiratoria/etiología , Gripe Humana/terapia , Hospitalización , Síndrome Mucocutáneo Linfonodular/complicaciones

RESUMEN

Influenza B virus (IBV) causes respiratory tract infections with mild, moderate, or life-threatening symptoms. This study describes the epidemiology of IBV infection in Rio Grande do Sul (RS), Brazil, over 17 years. Nasopharyngeal samples were collected from outpatients presenting acute respiratory illness (ARI) between 2003 and 2019, and from inpatients with severe acute respiratory infection (SARI) from 2009 to 2019. IBV was detected by immunofluorescence assay or quantitative real-time polymerase chain reaction; demographic and clinical data were analyzed. In total, 48,656 cases of respiratory infection were analyzed, of which 20.45% were ARI, and 79.46% were SARI. Respiratory viruses accounted for 22.59% and 37.47% of the cases of ARI and SARI, respectively. Considering respiratory viral infections, 17.10% of ARI and 3.06% of SARI were associated with IBV. IBV circulated year-round in RS, with an increase in autumn and winter, peaking in July (p = .005). IBV infection showed an association with age, and most outpatients positive for IBV were between 10 and 49 years old, whereas IBV infection in SARI affected mainly individuals ≤ 1 year or ≥ 60 years old. No significant association was found between sex and IBV infection. Coryza, sore throat, and myalgia were associated with ARI (p < .001). Moreover, 3.18% of the deaths associated with respiratory virus infection were positive for IBV; notably, cardiopathy (p < .001), metabolic disease (p < .001), and smoking (p = .003) were associated to fatality in IBV infection. IBV is an important cause of severe respiratory infections, and the fatality risk is high in individuals with cardiopathy and metabolic diseases.

Asunto(s)

Monitoreo Epidemiológico , Virus de la Influenza B/patogenicidad , Gripe Humana/epidemiología , Nasofaringe/virología , Infecciones del Sistema Respiratorio/virología , Adolescente , Adulto , Brasil/epidemiología , Niño , Preescolar , Femenino , Humanos , Lactante , Gripe Humana/complicaciones , Gripe Humana/diagnóstico , Gripe Humana/virología , Masculino , Persona de Mediana Edad , Pacientes Ambulatorios/estadística & datos numéricos , Infecciones del Sistema Respiratorio/diagnóstico , Estaciones del Año , Índice de Severidad de la Enfermedad , Adulto Joven

RESUMEN

Influenza B virus (IBV) causes respiratory infectious disease. Cytokines are important immune mediators during infectious diseases. Cortisol and stress have been related to respiratory infection susceptibility and cytokine regulation. Little is known about systemic cytokines, cortisol, and perceived stress in the early stages of IBV infection. We researched the systemic cytokines and cortisol, as well as the perceived stress and blood cell count in patients infected with IBV. The diagnosis was established using the Luminex xTAG RVP kit and confirmed with qRT-PCR for IBV viral load. The perceived stress was evaluated using the perceived stress scale (PSS-10). Twenty-five plasma cytokines were determined using multiplex immunoassay and cortisol by ELISA. The leukocyte differential count was measured with a standard laboratory protocol. Th1, Th17, and IL-10 cytokines were higher in IBV infected patients (P < 0.05). Leukocytes and neutrophil count negatively correlated with viral load (P < 0.05). Perceived stress had a negative effect on monocyte and systemic cytokines in IBV infected patients (P < 0.05). Cortisol was higher in patients infected with IBV and correlated positively with CCL20 (P < 0.05). Cortisol showed a positive effect on most of the systemic cytokines (P < 0.05). In conclusion, a cytokine pattern was found in IBV infected patients, as well as the possible role of leukocyte counts in the control of IBV. Our results suggest the importance of cortisol and perceived stress on systemic cytokines in patients infected with IBV, but more studies are needed to understand their role in cytokine production in respiratory infectious disease.

Asunto(s)

Citocinas/sangre , Hidrocortisona/sangre , Gripe Humana/sangre , Percepción , Estrés Psicológico , Adulto , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Virus de la Influenza B/metabolismo , Leucocitos/citología , Modelos Lineales , Masculino , Persona de Mediana Edad , Neutrófilos/metabolismo , Carga Viral

RESUMEN

Currently, 2 genotypes of Influenza B viruses (IFB) are cocirculating in humans: Victoria (VIC) and Yamagata (YAM). Infection and viral load (VL) were analyzed in 105 genotyped IFB (59 VIC and 46 YAM) out of 3452 respiratory samples from immunodepressed (ID), immunocompetent (IC) including outpatients (OP) and hospitalized patients (HP) attended during 2001-2013 at São Paulo Hospital. VL (Log10 RNA copies/mL) calculation was possible in 78 samples (47 VIC, 31 YAM). The age group of 12 to 18 years presented the highest detection (14.13%). Rates of infection among groups were of 3.67% (IC), 1.68% (ID), 3.50% (OP), 0.6% (HP), and VLs varied from 2.8 to 10.13 with no difference regarding age, immune status, and disease severity. From 10 OP vaccinated against influenza, 8 (7 children, 1 ID) received a matching strain shot (VIC), and 2 a monovalent influenza A H1N1pdm09. Those patients presented a VL of 6.31 ± 1.62 (mean ± SD). IFB infection rates follow an age pattern, but VL seems not to be related to frequency or clinical outcome. IFB patients with previous immunization could point to some protection for VIC infections since there was no HP. Other immunological aspects, such as lineage infection immune priming, previous infections, and vaccinations, should be further investigated.

Asunto(s)

Virus de la Influenza B/genética , Gripe Humana/virología , Infecciones del Sistema Respiratorio/virología , Carga Viral/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anticuerpos Antivirales/sangre , Brasil , Niño , Preescolar , Femenino , Humanos , Inmunización/estadística & datos numéricos , Lactante , Virus de la Influenza B/inmunología , Vacunas contra la Influenza/administración & dosificación , Gripe Humana/inmunología , Persona de Mediana Edad , Infecciones del Sistema Respiratorio/inmunología , Índice de Severidad de la Enfermedad , Centros de Atención Terciaria , Adulto Joven

RESUMEN

Most influenza vaccines in Mexico are trivalent, containing two influenza A strains and a single B strain. Quadrivalent influenza vaccines (QIVs) extend protection by including an additional B strain to cover both co-circulating B lineages. Here, we retrospectively estimated how a switch to QIV in Mexico would have impacted influenza-related health outcomes over the 2010/2011 to 2015/2016 influenza seasons, and prospectively estimated the budget impact of using QIV in Mexico's national immunization program from 2016/2017 to 2020/2021. For the retrospective estimation, we used an age-stratified static model incorporating Mexico-specific input parameters. For the prospective estimation, we used a budget impact model based on retrospective attack rates considering predicted future vaccination coverage. Between 2010/2011 and 2015/2016, a switch to QIV would have prevented 270,596 additional influenza cases, 102,000 general practitioner consultations, 140,062 days of absenteeism, 3,323 hospitalizations, and 312 deaths, saving Mex$214 million (US$10.8 million) in third-party payer costs. In the prospective analysis, a switch to QIV was estimated to prevent an additional 225,497 influenza cases, 85,000 general practitioner consultations, 116,718 days of absenteeism, 2,769 hospitalizations, and 260 deaths, saving Mex$178 million (US$9 million) in third-party payer costs over 5 years. Compared to the trivalent vaccine, the benefit and costs saved with QIV were sensitive to the distribution of influenza A vs. B cases and trivalent vaccine effectiveness against the mismatched B strain. These results suggest switching to QIV in Mexico would benefit healthcare providers and society by preventing influenza cases, morbidity, and deaths, and reducing associated use of medical resources.

Asunto(s)

Vacunas contra la Influenza , Gripe Humana , Análisis Costo-Beneficio , Humanos , Gripe Humana/epidemiología , Gripe Humana/prevención & control , México/epidemiología , Estudios Prospectivos , Salud Pública , Estudios Retrospectivos , Vacunas de Productos Inactivados

RESUMEN

La miocarditis es una enfermedad inflamatoria del miocardio. Las infecciones virales son la causa más común, aunque también puede deberse a reacciones de hipersensibilidad y de etiología autoinmunitaria, entre otras. El espectro clínico de la enfermedad es variado y comprende desde un curso asintomático, seguido de dolor torácico, arritmias y falla cardiaca aguda, hasta un cuadro fulminante. El término 'fulminante' se refiere al desarrollo de un shock cardiogénico con necesidad de soporte vasopresor e inotrópico o dispositivos de asistencia circulatoria, ya sea oxigenación por membrana extracorpórea o balón de contrapulsación intraaórtico. Cerca del 10 % de los casos de falla cardiaca por miocarditis corresponde a miocarditis fulminante. La miocarditis por influenza se considera una condición infrecuente; no obstante, su incidencia ha aumentado desde el 2009 a raíz de la pandemia de influenza por el virus AH1N1. Por su parte, la miocarditis por influenza de tipo B sigue siendo una condición infrecuente. Se describen aquí dos casos confirmados de miocarditis fulminante por el virus de la influenza B atendidos en un centro cardiovascular, que requirieron dispositivos de asistencia circulatoria mecánica.

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Myocarditis is an inflammatory disease of the myocardium. Viral infections are the most common cause, although it can also be due to hypersensitivity reactions and autoimmune etiology, among other causes. The clinical spectrum of the disease is varied, from an asymptomatic course, followed by chest pain, arrhythmias, and acute heart failure, to a fulminant episode. The term fulminant refers to the development of cardiogenic shock with a need for vasopressor support and inotropic or assisted circulation devices either extracorporeal membrane oxygenation (ECMO) or intra-aortic counterpulsation balloon. About 10% of cases of heart failure due to myocarditis correspond to fulminant myocarditis. Influenza myocarditis has been considered an infrequent condition. However, its incidence has increased since 2009 as a result of the AH1N1 pandemic; otherwise, myocarditis due to the Influenza type B virus remains an infrequent entity. We describe the experience in a cardiovascular center of two confirmed cases of fulminant myocarditis due to influenza B that required circulatory assistance devices.

Asunto(s)

Virus de la Influenza B , Gripe Humana/complicaciones , Miocarditis/etiología , Choque Cardiogénico/etiología , Lesión Renal Aguda/etiología , Lesión Renal Aguda/terapia , Apoyo Vital Cardíaco Avanzado , Antivirales/uso terapéutico , Terapia Combinada , Urgencias Médicas , Oxigenación por Membrana Extracorpórea , Resultado Fatal , Femenino , Hemofiltración , Humanos , Virus de la Influenza B/aislamiento & purificación , Gripe Humana/tratamiento farmacológico , Gripe Humana/virología , Contrapulsador Intraaórtico , Persona de Mediana Edad , Miocarditis/diagnóstico por imagen , Oseltamivir/uso terapéutico , Derrame Pericárdico/etiología , Choque Cardiogénico/tratamiento farmacológico , Choque Cardiogénico/terapia , Vasoconstrictores/uso terapéutico , Adulto Joven

RESUMEN

Resumen La miocarditis es una enfermedad inflamatoria del miocardio. Las infecciones virales son la causa más común, aunque también puede deberse a reacciones de hipersensibilidad y de etiología autoinmunitaria, entre otras. El espectro clínico de la enfermedad es variado y comprende desde un curso asintomático, seguido de dolor torácico, arritmias y falla cardiaca aguda, hasta un cuadro fulminante. El término 'fulminante' se refiere al desarrollo de un shock cardiogénico con necesidad de soporte vasopresor e inotrópico o dispositivos de asistencia circulatoria, ya sea oxigenación por membrana extracorpórea o balón de contrapulsación intraaórtico. Cerca del 10 % de los casos de falla cardiaca por miocarditis corresponde a miocarditis fulminante. La miocarditis por influenza se considera una condición infrecuente; no obstante, su incidencia ha aumentado desde el 2009 a raíz de la pandemia de influenza por el virus AH1N1. Por su parte, la miocarditis por influenza de tipo B sigue siendo una condición infrecuente. Se describen aquí dos casos confirmados de miocarditis fulminante por el virus de la influenza B atendidos en un centro cardiovascular, que requirieron dispositivos de asistencia circulatoria mecánica.

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Abstract Myocarditis is an inflammatory disease of the myocardium. Viral infections are the most common cause, although it can also be due to hypersensitivity reactions and autoimmune etiology, among other causes. The clinical spectrum of the disease is varied, from an asymptomatic course, followed by chest pain, arrhythmias, and acute heart failure, to a fulminant episode. The term fulminant refers to the development of cardiogenic shock with a need for vasopressor support and inotropic or assisted circulation devices either extracorporeal membrane oxygenation (ECMO) or intra-aortic counterpulsation balloon. About 10% of cases of heart failure due to myocarditis correspond to fulminant myocarditis. Influenza myocarditis has been considered an infrequent condition. However, its incidence has increased since 2009 as a result of the AH1N1 pandemic; otherwise, myocarditis due to the Influenza type B virus remains an infrequent entity. We describe the experience in a cardiovascular center of two confirmed cases of fulminant myocarditis due to influenza B that required circulatory assistance devices.

Asunto(s)

Femenino , Humanos , Persona de Mediana Edad , Adulto Joven , Virus de la Influenza B , Choque Cardiogénico/etiología , Gripe Humana/complicaciones , Miocarditis/etiología , Antivirales/uso terapéutico , Virus de la Influenza B/aislamiento & purificación , Derrame Pericárdico/etiología , Choque Cardiogénico/tratamiento farmacológico , Choque Cardiogénico/terapia , Vasoconstrictores/uso terapéutico , Oxigenación por Membrana Extracorpórea , Hemofiltración , Resultado Fatal , Terapia Combinada , Apoyo Vital Cardíaco Avanzado , Urgencias Médicas , Gripe Humana/tratamiento farmacológico , Gripe Humana/virología , Oseltamivir/uso terapéutico , Lesión Renal Aguda/etiología , Lesión Renal Aguda/terapia , Contrapulsador Intraaórtico , Miocarditis/diagnóstico por imagen

RESUMEN

Este trabalho verificou a dinâmica dos exames realizados para diagnóstico de Influenza no período de 2014 a 2016 e a faixa etária predominante em amostras recebidas pelo LACEN/MS. Objetivo:Avaliar e verificar o aumento no número de exames realizados para diagnóstico de Influenza. Métodos:Os dados foram provenientes de resultados de exames de pacientes de Mato Grosso do Sul realizados no período de 2014 a 2016 pela metodologia de transcriptase reversa, seguida de reação em cadeia de polimerase (RT-PCR) em Tempo Real. Resultados:Foram realizados 4.526 exames para diagnóstico de influenza "A" e "B", sendo detectável em 2014 (12,9%), 2015 (12,5%) e 2016 (40,0%). Verificou-se um aumento de exames nos anos de 2014 e 2016 com predomínio na faixa etária de 20 a 59. Quanto a influenza "A" (H1N1) foram encontrados em 2014, 82;2015, 05;e 2016, 806;sendo a faixa etária de 40 a 59 anos com maior ocorrência.No período de estudo houve 101 óbitos por influenza no estado, sendo em 2016, 63 mortes causadas por H1N1. Conclusão:O estudo permitiu verificar a importância de outras faixas etárias serem incluídas em campanhas de vacinação visando minimizar a incidência de casos confirmados em trabalhadores da faixa etária de 40 a 59 anos e que as políticas de prevenção aliadas a um planejamento estratégico sejam estruturadas garantindo que todos sejam contemplados pela imunização.

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This paper verified the dynamics of the tests performed to diagnose Influenza in the period from 2014 to 2016 and the predominant age range in samples received by LACEN / MS. Objective:Evaluate and verify the increase in the examinations for the diagnosis of Influenza.Methods:The data were obtained from the results of patients from Mato Grosso do Sul from 2014 to 2016 by reverse transcriptase methodology, followed by real-time polymerase chain reaction (rRT-PCR). Results:During that period, 4,526 examinations were carried out to diagnose influenza A and B, and could be detected in 2014 (12.9%), 2015 (12.5%) and 2016 (40.0%). There was an increase in the exams in the years of 2014 and2016, with a predominance in the age group from 20 to 59 years old of about 58%. For influenza "A" (H1N1) were found in 2014, 82 (44.0%), 2015, 05 (4.6%) and 2016, 806 (92.0%), being the age group from 40 to 59 the most frequent, 256 (29.2%) were confirmed in 2016, followed by 29 (15.6%) in 2014. In the year 2015, 72 (53.5%) of H3N2 were detected. Influenza "B" ranged from 2.1% (2014) to 29.4% (2015). During the period of this research there were 101 deaths from influenza in the state, being in 2016, 63 deaths caused by H1N1. Conclusion:The study made it possible to verify the importance of other age groups be included in vaccination campaigns in order to minimize the incidence of confirmed cases in workers aged from 40 to 59 years and that prevention policies combined with strategic planning are structured to ensure the immunization to everyone.

Asunto(s)

Humanos , Pacientes , Inmunización , Diagnóstico , Gripe Humana , Salud Pública , Programas de Inmunización

RESUMEN

RESUMEN Fundamento: las infecciones respiratorias agudas constituyen la causa principal de morbilidad a nivel mundial, al ser sus principales agentes etiológicos los virus respiratorios. Objetivo: determinar el papel de diferentes virus respiratorios en la causa de la infección respiratoria aguda grave durante el período mayo 2012 - junio 2013, en Cuba. Métodos: se realizó un estudio analítico transversal, el universo fueron las muestras clínicas recibidas en el Laboratorio Nacional de Referencia (LNR) de Virus Respiratorios del Instituto de Medicina Tropical Pedro Kourí (IPK) como parte de la vigilancia de las IRA de posible etiología viral, desde el 1 de mayo de 2012 y el 30 de junio de 2013. Se estudiaron 1 604 muestras procedentes de pacientes de todas las edades con manifestaciones clínicas. Para el diagnóstico se emplearon tres ensayos de TR-RCP múltiple de tipo anidado y un TR-RCP en tiempo real. Resultados: los rinovirus fueron los agentes más identificados, seguidos de los virus Influenza y del virus sincitial respiratorio. Los de mayor frecuencia en los pacientes con infección respiratoria aguda grave fueron los virus Influenza se demostró asociación significativa (OR 6,437; 95 % IC: 3,407-12,159; p=0,000) y en los pacientes <1 año se encontró también asociación con la detección del virus sincitial respiratorio; hubo correlación también en la población de 15-59 años con los virus Influenza (p=0,000). El virus Influenza B circuló entre los meses de mayo y septiembre del año 2012, mientras que el virus Influenza A (H1N1) pdm09 predominó en la circulación durante el 2013. Conclusiones: los resultados de esta investigación permiten esclarecer la contribución específica de los diferentes virus respiratorios en la causa de dicha enfermedad. Al mismo tiempo alertan a los programas nacionales la necesidad de centralizar los esfuerzos de la vigilancia en este tipo de infección para la identificación oportuna de eventos de salud inusitados por los virus Influenza.

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ABSTRACT Background: acute respiratory infections are the main cause of mortality and morbidity worldwide, with respiratory viruses as main causative agents. Objective: to determine the paper of different respiratory viruses in the etiology of the severe acute respiratory infections during the period May 2012- June 2013, in Cuba. Methods: a transverse analytical study was carried out, the universe there were the clinical samples received in the National Laboratory of Reference (LNR) of Respiratory Viruses of the Institute of Tropical Medicine Pedro Kourí (IPK) as part of the alertness of the IRA of possible viral etiology, from May 1, 2012 and June 30, 2013. There were studied 1 604 samples proceeding from patients of all the ages with clinical declarations. For the diagnosis, there were used three essays of multiple TR-RCP of sheltered type and a TR-RCP in real-time. Results: rhinoviruses were the agents largely identified, followed by the Influenza viruses and the respiratory syncytial virus. The ones of bigger frequency in patients with severe acute respiratory infection were Influenza viruses demonstrating significant association (OR 6,437; 95 % CI: 3,407-12,159; p= 0,000) and in patients <1 year old it was also found association with the detection of respiratory syncytial virus; correlation was also in the population of 15-59 years with the viruses Influenza (p= 0,000). The Influenza virus B circulated mainly between the months of May and September of the year 2012, while the virus Influenza A (H1N1) pdm09 predominated during 2013. Conclusions: the results of this investigation allow explaining the specific contribution of the different respiratory viruses in the etiology of said pathology. At the same time, they alert the national programs of the need to centralize the efforts in vigilance of this type of infection to achieve opportune identification of health events unusual for the viruses Influenza.

Asunto(s)

Haemophilus influenzae tipo b

RESUMEN

As from January to August 2013, epidemiological weeks 1-35 (EW), Influenza incidence, case characteristics, types and subtypes of circulating influenza virus in the Nacional Profesor Alejandro Posadas Hospital were studied, and were compared to incidences during 2009-2012. From late May to the end of August 2013 (EW18-35), an increase was observed in the proportion of patients' visits for respiratory disease, influenza-like illness and hospitalizations due to pneumonia; of 207 cases diagnosed with influenza A virus, 153 were infected by H1N1pdm09, 46 by H3, and eight without subtype. The highest proportion of cases was found in children under five years of age, followed by the group 60-64. The chances of having the illness were three times greater among the group 40-64 years old compared to 15-39 or those older than 64. Mortality, which increased with age, was 7.2%, and the odds of death were six times higher among those older than 64. Vaccination rate among the cases was 11.6%. None of the fatal cases had received the vaccine. After the 2009 pandemic, the proportions of annual patients' visits decreased until 2012; in 2013, an increase of 52.0% during the winter period compared to 2012. The viral circulation started earlier in 2013 compared to previous years. FLU-A(H1N1pdm) was the predominant circulating virus in 2009 and 2013, FLU-A(H3) in 2011, FLU-A(H3) and FLU-B in both 2010 and 2012.

Asunto(s)

Gripe Humana/epidemiología , Pandemias/estadística & datos numéricos , Vacunación/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Argentina/epidemiología , Niño , Preescolar , Femenino , Estudios de Seguimiento , Hospitalización/estadística & datos numéricos , Humanos , Incidencia , Lactante , Gripe Humana/diagnóstico , Gripe Humana/prevención & control , Masculino , Persona de Mediana Edad , Nasofaringe/metabolismo , Orthomyxoviridae/clasificación , Orthomyxoviridae/aislamiento & purificación , Estudios Prospectivos , Estudios Retrospectivos , Factores de Riesgo , Estaciones del Año , Adulto Joven

RESUMEN

En el Hospital Nacional Profesor Alejandro Posadas se estudiaron la incidencia de influenza, las características de casos y tipos y subtipos de virus circulantes de enero a agosto de 2013 inclusive, semanas epidemiológicas (SE) 1-35, y se compararon con los años 2009-2012. De fin de mayo a agosto inclusive de 2013 (SE 18 a 35) se observó un aumento del porcentaje de consulta por enfermedades respiratorias, enfermedad tipo influenza e internación por neumonía y se diagnosticaron 207 casos: 153 influenza A (FLU-A)(H1N1pdm09), 46 A(H3), ocho A(sin subtipificar). La mayor frecuencia fue en menores de 5 años, seguida por el grupo de 60 a 64.La chance de tener la enfermedad fue tres veces mayor en el grupo de 40-64 años versus 15-39 o > 64 años. La letalidad, que aumentó con la edad, fue de 7.2% y la chance de morir fue seis veces mayor en los > 64 años. El porcentaje de vacunación entre los casos fue11.6%. Ninguno de los fallecidos estaba vacunado. Luego de la pandemia de 2009 el porcentaje de consultas anuales disminuyó hasta 2012, con un aumento en el período invernal de 2013 de 52.0% con respecto a 2012. La circulación viral en 2013 fue más temprana que en los años anteriores. En 2009 y 2013 la mayor circulación fue FLU-A (H1N1pdm), en 2011 FLU-A(H3) y en 2010 y 2012 FLU-A(H3) y FLU-B.(AU)

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As from January to August 2013, epidemiological weeks 1-35 (EW), Influenza incidence, case characteristics, types and subtypes of circulating influenza virus in the Nacional Profesor Alejandro Posadas Hospital were studied, and were compared to incidences during 2009-2012. From late May to the end of August 2013 (EW18-35), an increase was observed in the proportion of patients visits for respiratory disease, influenza-like illness and hospitalizations due to pneumonia; of 207 cases diagnosed with influenza A virus, 153 were infected by H1N1pdm09, 46 by H3, and eight without subtype. The highest proportion of cases was found in children under five years of age, followed by the group 60-64.The chances of having the illness were three times greater among the group 40-64 years old compared to 15-39 or those older than 64. Mortality, which increased with age, was 7.2%, and the odds of death were six times higher among those older than 64. Vaccination rate among the cases was 11.6%. None of the fatal cases had received the vaccine. After the 2009 pandemic, the proportions of annual patients´ visits decreased until 2012; in 2013, an increase of 52.0% during the winter period compared to 2012. The viral circulation started earlier in 2013 compared to previous years. FLU-A(H1N1pdm) was the predominant circulating virus in 2009 and 2013, FLU-A(H3) in 2011, FLU-A(H3) and FLU-B in both 2010 and 2012.(AU)

RESUMEN

En el Hospital Nacional Profesor Alejandro Posadas se estudiaron la incidencia de influenza, las características de casos y tipos y subtipos de virus circulantes de enero a agosto de 2013 inclusive, semanas epidemiológicas (SE) 1-35, y se compararon con los años 2009-2012. De fin de mayo a agosto inclusive de 2013 (SE 18 a 35) se observó un aumento del porcentaje de consulta por enfermedades respiratorias, enfermedad tipo influenza e internación por neumonía y se diagnosticaron 207 casos: 153 influenza A (FLU-A)(H1N1pdm09), 46 A(H3), ocho A(sin subtipificar). La mayor frecuencia fue en menores de 5 años, seguida por el grupo de 60 a 64.La chance de tener la enfermedad fue tres veces mayor en el grupo de 40-64 años versus 15-39 o > 64 años. La letalidad, que aumentó con la edad, fue de 7.2% y la chance de morir fue seis veces mayor en los > 64 años. El porcentaje de vacunación entre los casos fue11.6%. Ninguno de los fallecidos estaba vacunado. Luego de la pandemia de 2009 el porcentaje de consultas anuales disminuyó hasta 2012, con un aumento en el período invernal de 2013 de 52.0% con respecto a 2012. La circulación viral en 2013 fue más temprana que en los años anteriores. En 2009 y 2013 la mayor circulación fue FLU-A (H1N1pdm), en 2011 FLU-A(H3) y en 2010 y 2012 FLU-A(H3) y FLU-B.

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As from January to August 2013, epidemiological weeks 1-35 (EW), Influenza incidence, case characteristics, types and subtypes of circulating influenza virus in the Nacional Profesor Alejandro Posadas Hospital were studied, and were compared to incidences during 2009-2012. From late May to the end of August 2013 (EW18-35), an increase was observed in the proportion of patients' visits for respiratory disease, influenza-like illness and hospitalizations due to pneumonia; of 207 cases diagnosed with influenza A virus, 153 were infected by H1N1pdm09, 46 by H3, and eight without subtype. The highest proportion of cases was found in children under five years of age, followed by the group 60-64.The chances of having the illness were three times greater among the group 40-64 years old compared to 15-39 or those older than 64. Mortality, which increased with age, was 7.2%, and the odds of death were six times higher among those older than 64. Vaccination rate among the cases was 11.6%. None of the fatal cases had received the vaccine. After the 2009 pandemic, the proportions of annual patients´ visits decreased until 2012; in 2013, an increase of 52.0% during the winter period compared to 2012. The viral circulation started earlier in 2013 compared to previous years. FLU-A(H1N1pdm) was the predominant circulating virus in 2009 and 2013, FLU-A(H3) in 2011, FLU-A(H3) and FLU-B in both 2010 and 2012.

Asunto(s)

Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Adulto Joven , Gripe Humana/epidemiología , Pandemias/estadística & datos numéricos , Vacunación/estadística & datos numéricos , Factores de Edad , Argentina/epidemiología , Estudios de Seguimiento , Hospitalización/estadística & datos numéricos , Incidencia , Gripe Humana/diagnóstico , Gripe Humana/prevención & control , Nasofaringe , Orthomyxoviridae/clasificación , Orthomyxoviridae/aislamiento & purificación , Estudios Prospectivos , Estudios Retrospectivos , Factores de Riesgo , Estaciones del Año

RESUMEN

Anualmente la influenza causa aproximadamente 3.5 millones de casos severos en el mundo. Objetivo: Describir y analizar la situación epidemiológica de la influenza y apoyar el fortalecimiento de su sistema de vigilancia. Métodos: Estudio descriptivo retrospectivo. Se calculó incidencia, riesgo relativo, RR, intervalo de confianza al 95 por ciento, IC 95 por ciento, y número de egresos con sus promedios móviles, tasas de egreso hospitalario de influenza y neumonía. Fuentes de datos: los registros de notificación colectiva del Ministerio de Salud, la base de datos de egresos hospitalarios del Seguro Social y los registros de la vigilancia centinela del Centro Nacional de Influenza. Resultados: La incidencia anual mostró tendencia al aumento, R2 igual 0.9, con picos en marzo a abril, junio a septiembre y agosto a diciembre. Las tasas anuales de egreso hospitalario mostraron tendencia a disminuir, R2 igual 0.9, con picos en marzo a mayo, julio a septiembre y septiembre a octubre. El pico de aislamientos del laboratorio se presentó en el segundo semestre de cada año, más frecuente en los meses de julio, agosto y septiembre. discusión: Se cotejaron los datos de la vigilancia, los egresos hospitalarios y el laboratorio, los resultados no fueron suficientes para concluir si la influenza muestra estacionalidad. Se sugiere realizar un estudio del sistema de vigilancia de influenza para mejorar la calidad y el registro de los datos ya que es fundamental conocer la estacionalidad de la influenza y sus cambios para respaldar las intervenciones correspondientes y sus modificaciones.

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Objective: To describe and analyze the influenza epidemiological situation in the past four years in order to support enhancement of the influenza surveillance system in Costa Rica.Methods: A descriptive, retrospective study was conducted. Incidence and hospital discharge rates were calculated. Sources of data were: collective notification forms of the Ministry of Health, the hospital discharge data base of the Costa Rican Social Security system as well as the influenza surveillance forms of the National Influenza Center. Results: Since 2005 collective information has been gathered monthly, by province, by age-groups and sex. From 2005 through 2006, the highest rates were found in the months of March and May. Regarding hospital discharges, mobile averages showed that a peak was reached between June and September. Laboratory diagnoses were highest during the months of July through September. Discussion: Collective notification is higher in the first semester; nevertheless, hospital discharge rates are higher between June and September which match the peak reached by laboratory diagnoses for influenza virus; this may suggest seasonality but there is a lack of robust data to confirm this; therefore, we suggest conducting further seasonality studies. This study supports the development of guidelines for the influenza surveillance process in Costa Rica.

Asunto(s)

Humanos , Enfermedades Transmisibles , Virus de la Influenza A , Virus de la Influenza B , Gripe Humana/diagnóstico , Gripe Humana/epidemiología , Costa Rica