Cjepivo protiv influence i kriteriji Svjetske zdravstvene organizacije (SZO) (Influenza immunization and WHO criteria)

Gripa je visoko kontagiozna virusna infekcija gornjeg respiratornog trakta, a jedna je od najtežih bolesti u zimskom razdoblju godine. Može dovesti do velikog broja hospitaliziranih, komplikacija i smrtnosti, posebno u starijih. Godišnje se 10-20% populacije inficira virusom influence, a bolest zahvaća sve dobne skupine s najtežim posljedicama u starijih osoba. Cijepljenje je najuspješnija i najjeftinija metoda sprječavanja infektivnih bolesti, što dokazuju rezultati cijepljenja protiv variole, tuberkuloze, difterije, tetanusa, pertusisa, poliomijelitisa, morbila, parotitisa, rubeole, hepatitisa itd. Cjepivo protiv influence prvi put je proizvedeno 1940. godine na oplođenim kokošjim jajima, u obliku inaktiviranih virusnih čestica, te je odmah postalo jasno da utječe na smanjenje smrtnosti i broj oboljelih od gripe.

„Knjiga o gripi - što donosi budućnost?

U okviru Nacionalnog centra za influencu, a sve u cilju širenja javnozdravstvenih spoznaja u svezi s gripom, te ublažavanju posljedica u slučaju pandemije izdana je knjiga: Kamps-Hoffmann-Preiser «Knjiga o gripi » koju je adaptirao i preveo dr. V. Draženović.Ova knjiga prvi je tako sveobuhvatni pisani tekst na hrvatskom jeziku koji na stručan ali pristupačan način govori o svim aspektima gripe i to kroz deset poglavlja .Poglavlja obuhvaćaju sljedeće teme: sezonsku influencu, ptičju gripu, pandemije, pripreme za pandemiju, strukturu virusa influence, patogenezu i imunologiju, cjepiva, laboratorijsku dijagnostiku, kliničku sliku, liječenje i preventivne aktivnosti te nove protuvirusne lijekove

„Knjiga o gripi - što donosi budućnost?

U okviru Nacionalnog centra za influencu, a sve u cilju širenja javnozdravstvenih spoznaja u svezi s gripom, te ublažavanju posljedica u slučaju pandemije izdana je knjiga: Kamps-Hoffmann-Preiser «Knjiga o gripi » koju je adaptirao i preveo dr. V. Draženović.Ova knjiga prvi je tako sveobuhvatni pisani tekst na hrvatskom jeziku koji na stručan ali pristupačan način govori o svim aspektima gripe i to kroz deset poglavlja .Poglavlja obuhvaćaju sljedeće teme: sezonsku influencu, ptičju gripu, pandemije, pripreme za pandemiju, strukturu virusa influence, patogenezu i imunologiju, cjepiva, laboratorijsku dijagnostiku, kliničku sliku, liječenje i preventivne aktivnosti te nove protuvirusne lijekove

Protutijela za viruse humane influence u prokazivačkih pataka u ornitološkom rezervatu Kopački rit.

Direct transmission of avian influenza viruses to humans has been confifi rmed and ever since it has been the main topic of influenza virus research. The opposite form of virus transmission is still unclear. In our study we used duck flocks as sentinels for surveillance of wild birds for influenza viruses and the possibility of bird infections with human influenza A viruses. Tested sera were collected from ducks in a free breeding system on a fish pond in the ornithological reserve Kopački rit (Croatia). Ducks were bred in an isolated unit for the first three weeks, and this was followed by four weeks breeding on the fifi sh pond without contact with humans. Sera were tested by haemagglutination inhibition (HI) test using human influenza viruses A/New Caledonia/20/99/ VR-116 (H1N1), A/Panama/2007/99 (RESVIR - 17) (H3N2), B/Hong Kong/330/01 and B/Sichuana/379/99 as antigens. To determine the time of infection, sera were collected twice during the period of isolation (day 0 and day 21) and at the end of breeding (day 49). Sera collected during the period of isolation were negative to influenza A and influenza B viruses. The high titer of influenza A specific antibodies in the serum samples at the end of breeding confirmed infection during exposure on the fish pond. As ducks on the fish pond had no contact with humans and were only in close contact with wild migratory birds these results confirmed that wild migratory birds were a source of infection and present a reservoir of influenza viruses. Very high seroprevalence in sentinel ducks with a high HI titers in some animals was determined at the end of breeding. The results of this study indicate that sentinel ducks were infected with influenza A virus strains closely related to the human strains used as an antigen. Also this study confirmed that sentinel ducks could be successfully used in influenza monitoring in wild birds.Mogućnost prijenosa ljudskih sojeva virusa influence izravno s ljudi na ptice još uvijek nije dovoljno istražena. U ovom radu prikazana je uporaba domaćih pataka kao modela prokazivačkih (engl. sentinel) životinja za promatranje širenja influence u divljih ptica, te je pomoću njih istražena infekcije ptica virusima influence antigenski bliskim humanim sojevima. Pretraživani su uzorci seruma pataka slobodno držanih na ribnjaku u ornitološkom rezervatu Kopački Rit. Patke su prva tri tjedna bile uzgajane u zatvorenom objektu, a potom su sljedeća četiri tjedna bile uzgajane na ribnjaku bez dodira s ljudima. Serumi su bili uzorkovani nultoga i 21. dana u zatvorenom objektu te 49. dana, tj. nakon završetka uzgoja na ribnjaku. Svi uzorci seruma bili su pretraženi inhibicijom hemaglutinacije, a kao antigeni bili su rabljeni humani sojevi virusa influence A/New Caledonia/20/99/VR-116 (H1N1) i A/Panama/2007/99 (RESVIR - 17) (H3N2), te humani sojevi virusa nfluence B/Hong Kong/330/01 i B/Sichuana/379/99. Svi pretraženi uzorci seruma uzeti u zatvorenom objektu nultog i 21. dana uzgajanja bili su negativni, dok su u uzorcima seruma uzetima na kraju uzgoja na ribnjaku (49. dana) ustanovljena specifična protutijela za viruse influence tipa A. Ovi rezultati potvrđuju infekciju pataka tijekom boravka na ribnjaku bez kontakta s ljudima što dokazuje da su divlje ptice bile izvor zaraze. Visoka seroprevalencija, te poglavito visoki titri specifičnih protutijela u pojedinih životinja dokaz su infekcije virusima influence antigenski srodnima humanim sojevima rabljenima u testu inhibicije hemaglutinacije. Postignuti rezultati potvrđuju mogućnost uporabe jata domaćih pataka kao prokazivačkih životinja za promatranje širenja influence u divljih ptica, te upućuju na nužnost daljnjega istraživanja mogućnosti infekcije ptica humanim sojevima virusa influence

Clinical and epidemiological characteristics of hospitalized patients with pandemic A(H1N1) 2009 influenza

Pandemijski virus influence A (H1N1) 2009 u nas se pojavio u srpnju, intenzivniji val bolesti zabilježen je u listopadu, studenome i prosincu 2009. godine, a bolest se pojavljivala sve do ožujka 2010. godine. U Hrvatskoj je registrirano 58 255 oboljelih od pandemijske gripe, a umrlo ih je 58, od toga 32 s laboratorijski dokazanim virusom. U razdoblju od 1. srpnja 2009. do 31. ožujka 2010. godine u Klinici za infektivne bolesti "Dr. Fran Mihaljević" u Zagrebu pregledano je 3 856 bolesnika s dijagnozom influence i/ili komplikacija. Od toga broja hospitalizirana su 562 (14,6 %) bolesnika. Od ukupnog broja hospitaliziranih, djece do 14 godina bilo je 140 (24,9 %), do 18 godina 154 (27,4 %), a odraslih gotovo triput više, odnosno 408 (72,6 %). U jedinicama intenzivne skrbi liječeno je 68 (12,1 %) bolesnika. Umrlo je 15 odraslih bolesnika, od kojih je 14 liječeno u jedinici intenzivnog liječenja. Stopa smrtnosti za sve hospitalizirane bolesnike (562) iznosi 2,7 %, za hospitalizirane odrasle (408) 3,7 %, a za odrasle liječene u jedinici intenzivne skrbi 26,4 %. Nije umrlo niti jedno dijete. Od 562 hospitalizirana bolesnika, virus pandemijske influence A(H1N1) 2009 dokazan je PCR metodom u njih 169 (30,1 %). Pandemijski virus influence otkriven je u 41,6 % hospitalizirane djece i u 25,7 % odraslih. U jedinicama intenzivne skrbi s dokazanim virusom liječeno je 35 (20,7 %) bolesnika, 22 odrasla i 13 djece. Prosječna dob svih bolesnika s dokazanim pandemijskim virusom (169) iznosila je 30,2 godina. U dječjoj skupini prosječna je dob bila 5,6 godina, a kod odraslih 45,2 godina. U odnosu na odrasle, djeca su prije dolazila i imala su znatno kraći boravak u bolnici, a u njih su zabilježene statistički značajno niže vrijednosti CRP-a, CK i sedimentacije eritrocita. U 169 bolesnika s dokazanim pandemijskim virusom influence ukupno je registrirano 227 rizičnih čimbenika, a zabilježeni su kod 95 (56,2 %) bolesnika. U odraslih su rizični imbenici zabilježeni znatno češće i u većem broju nego u djece. Najučestaliji rizični čimbenici bile su kronične plućne bolesti: astma u 29 (17,2 %) bolesnika i kronična opstruktivna plućna bolest (KOPB) u 27 (15,9 %) bolesnika. Registrirano je 240 komplikacija bolesti u 117 (69,2 %) bolesnika. Komplikacije su se češće pojavljivale i prosječno su bile teže u odraslih nego u djece. Pneumonija je bila najučestalija komplikacija, a registrirana je u 84/169 bolesnika, odnosno u svakog drugog hospitaliziranog bolesnika s dokazanim virusom pandemijske influence. Pneumonija je bila mnogo češća komplikacija u odraslih (66/105 ili 62,9 %) nego u djece (18/64 ili 28,1 %). Primarna virusna pneumonija registrirana je dvaput češće od sekundarne bakterijske (55:29 bolesnika). Zbog pandemijske influence 2009/10. godine hospitalizirano je 2,7 puta više odraslih nego djece (408:154), za razliku od deset prethodnih sezona influence kada su djeca bila 1,2 puta češće hospitalizirana od odraslih (759:656). Nameće se zaključak da je pandemijska influenca bila znatno teža i smrtonosnija bolest u usporedbi sa sezonskom, posebno u dobnim skupinama mlađih odraslih ljudi, iako pandemijom nije bio zahvaćen veći postotak pučanstva.Pandemic influenza A (H1N1) 2009 virus was first recorded in Croatia in July, and a more intense wave was recorded in October, November and December 2009, with the disease occurring throughout March 2010. Atotal of 58.255 pandemic influenza cases were recorded in Croatia, with 58 deaths, of whom 32 patients with laboratory confirmed virus. In the period from July 1, 2009 until March 31, 2010, a total of 3.856 patients with diagnosed influenza and/or complications were examined at the University Hospital for Infectious Diseases "Dr Fran Mihaljevic", Zagreb. Altogether 562 (14,6 %) patients were hospitalized, of whom 140 (24,9 %) children under 14 years of age, 154 (27,4 %) children aged between 14–18 years, with three times more adults hospitalized – 408 (72,6 %) in total. Atotal of 68 (12,1 %) patients were treated at intensive care unit (ICU). Fifteen adult patients died, of whom 14 treated in ICU. The mortality rate for all 562 hospitalized patients was 2,7 %, for 408 hospitalized adults 3,7 %, and for adults treated in ICU 26,4 %. No deaths were recorded among children. Out of 562 hospitalized patients, pandemic influenza A (H1N1) 2009 virus was detected by PCR method in 169 (30,1 %) patients. Pandemic influenza virus was detected in 41,6 % of hospitalized children and in 25,7 % of adults. In total, 35 (20,7 %) patients with confirmed virus were treated in ICU (22 adults and 13 children). The average age of all 169 patients with confirmed pandemic virus was 30,2 years. The average age of children was 5,6 years, and of adults 45,2 years. Compared to adults, children reported to hospital sooner and had a significantly shorter hospital stay, with recorded statistically significant lower values of CRP, CK and erythrocyte sedimentation rate. Out of 169 cases with confirmed pandemic influenza virus, altogether 227 risk factors were recorded in 95 (56,2 %) patients. Risk factors were more frequent and more numerous in adults than in children. The most commonly recorded risk factors were chronic pulmonary diseases – asthma in 29 patients (17,2 %) and chronic obstructive pulmonary disease (COPD) in 27 (15,9 %). We also recorded 240 disease complications in 117 (69,2 %) patients. Complications were more common and, on average, more severe in adults than in children. Pneumonia was the most frequent complication, and was recorded in 84/169 patients, i.e. in every second hospitalized patient with confirmed pandemic influenza virus. Pneumonia was more frequent complication in adults (66/105 or 62,9 %) than in children (18/64 or 28,1 %). Primary viral pneumonia was twice more frequent than secondary bacterial (55:29 patients). Due to pandemic 2009/10 influenza, 2,7 times more adults than children were hospitalized (408:154), while in ten previous influenza seasons, children were 1,2 times more often hospitalized than adults (759:656). Aconclusion is imposed that pandemic influenza was more severe and lethal disease compared to seasonal influenza, especially among younger adults, although the pandemic did not affect a higher percentage of the population

Protutijela za viruse humane influence u prokazivačkih pataka u ornitološkom rezervatu Kopački rit.

Direct transmission of avian influenza viruses to humans has been confifi rmed and ever since it has been the main topic of influenza virus research. The opposite form of virus transmission is still unclear. In our study we used duck flocks as sentinels for surveillance of wild birds for influenza viruses and the possibility of bird infections with human influenza A viruses. Tested sera were collected from ducks in a free breeding system on a fish pond in the ornithological reserve Kopački rit (Croatia). Ducks were bred in an isolated unit for the first three weeks, and this was followed by four weeks breeding on the fifi sh pond without contact with humans. Sera were tested by haemagglutination inhibition (HI) test using human influenza viruses A/New Caledonia/20/99/ VR-116 (H1N1), A/Panama/2007/99 (RESVIR - 17) (H3N2), B/Hong Kong/330/01 and B/Sichuana/379/99 as antigens. To determine the time of infection, sera were collected twice during the period of isolation (day 0 and day 21) and at the end of breeding (day 49). Sera collected during the period of isolation were negative to influenza A and influenza B viruses. The high titer of influenza A specific antibodies in the serum samples at the end of breeding confirmed infection during exposure on the fish pond. As ducks on the fish pond had no contact with humans and were only in close contact with wild migratory birds these results confirmed that wild migratory birds were a source of infection and present a reservoir of influenza viruses. Very high seroprevalence in sentinel ducks with a high HI titers in some animals was determined at the end of breeding. The results of this study indicate that sentinel ducks were infected with influenza A virus strains closely related to the human strains used as an antigen. Also this study confirmed that sentinel ducks could be successfully used in influenza monitoring in wild birds.Mogućnost prijenosa ljudskih sojeva virusa influence izravno s ljudi na ptice još uvijek nije dovoljno istražena. U ovom radu prikazana je uporaba domaćih pataka kao modela prokazivačkih (engl. sentinel) životinja za promatranje širenja influence u divljih ptica, te je pomoću njih istražena infekcije ptica virusima influence antigenski bliskim humanim sojevima. Pretraživani su uzorci seruma pataka slobodno držanih na ribnjaku u ornitološkom rezervatu Kopački Rit. Patke su prva tri tjedna bile uzgajane u zatvorenom objektu, a potom su sljedeća četiri tjedna bile uzgajane na ribnjaku bez dodira s ljudima. Serumi su bili uzorkovani nultoga i 21. dana u zatvorenom objektu te 49. dana, tj. nakon završetka uzgoja na ribnjaku. Svi uzorci seruma bili su pretraženi inhibicijom hemaglutinacije, a kao antigeni bili su rabljeni humani sojevi virusa influence A/New Caledonia/20/99/VR-116 (H1N1) i A/Panama/2007/99 (RESVIR - 17) (H3N2), te humani sojevi virusa nfluence B/Hong Kong/330/01 i B/Sichuana/379/99. Svi pretraženi uzorci seruma uzeti u zatvorenom objektu nultog i 21. dana uzgajanja bili su negativni, dok su u uzorcima seruma uzetima na kraju uzgoja na ribnjaku (49. dana) ustanovljena specifična protutijela za viruse influence tipa A. Ovi rezultati potvrđuju infekciju pataka tijekom boravka na ribnjaku bez kontakta s ljudima što dokazuje da su divlje ptice bile izvor zaraze. Visoka seroprevalencija, te poglavito visoki titri specifičnih protutijela u pojedinih životinja dokaz su infekcije virusima influence antigenski srodnima humanim sojevima rabljenima u testu inhibicije hemaglutinacije. Postignuti rezultati potvrđuju mogućnost uporabe jata domaćih pataka kao prokazivačkih životinja za promatranje širenja influence u divljih ptica, te upućuju na nužnost daljnjega istraživanja mogućnosti infekcije ptica humanim sojevima virusa influence

Epidemiologija influence u Hrvatskoj i pripreme za moguću pandemiju

Surveillance of influenza in Croatia is based on notification of disease/death due to communicable diseases that are reported within 24 hours (during the influenza season weekly aggregated reports are submitted) to the Epidemiology Service of the Croatian National Institute of Public Health (CNIPH). Field investigation of each cluster is conducted and samples are sent to the CNIPH National laboratory for influenza. The registered influenza morbidity in Croatia amounts to up to 191,000 cases annually, oscillating, in the interpandemic period, from several thousand to over 190,000. Average annual notification rate during last five years was 168/10000 inhabitants. Based on health service notification in the season 1957/58, Asian influenza pandemic A/Singapore/H2N2 caused illness in more than 500,000 people. The Hong Kong pandemic influenza (A/Hong Kong/H3N2) was registered in Croatia in the 1967/68 and 1969/70 season. Total number of notified influenza cases during that period was 582,000 people (14% of inhabitants). During the Hong Kong influenza pandemic morbidity higher than 1,000/10,000 inhabitants was recorded both in children aged 7?19 years and in persons aged 20+ years. The Preparedness Plan for Pandemic influenza is based on historical morbidity data in previous pandemic influenza outbreaks in the country. The brief overview of preparedness plan was given using the phases of interpandemic and pandemic period according to the latest agreed definitions published by the WHO.Nadzor nad gripom u Hrvatskoj zasniva se na prijavi oboljenja/smrti od zaraznih bolesti o kojima se unutar 24 sata obavještava (tijekom sezone influence tjedno se dostavljaju kumulativna izvješća) Služba za epidemiologiju Hrvatskog zavoda za javno zdravstvo. Provodi se epidemiološki izvid svakog pojedinog grupiranja, a uzorci se šalju Nacionalnom laboratoriju za influencu pri Hrvatskom zavodu za javno zdravstvo. Registrirani morbiditet od influence u Hrvatskoj iznosi 191,000 slučajeva godišnje te oscilira u interpandemijskom periodu od nekoliko tisuća pa do 190,000 slučajeva godišnje. Prosječni broj prijava u posljednjih pet godina iznosi 168 na 10000 stanovnika. Prema prijavama zdravstvenih službi za sezonu 1957/58, pandemija azijske influence A/Singapur/H2N2 uzrokovala je bolest kod više od 500,000 osoba. Pandemija hongkonške inlfuence (A/Hong Kong/H3N2) registrirana je u Hrvatskoj u sezonama 1967./68. i 1969./70. Ukupni broj prijavljenih slučajeva influence tijekom tog perioda iznosio je 582,000 osoba (14% stanovnika). Tijekom pandemije hongkonške influence morbiditet veći od 1,000/10,000 stanovnika zabilježen je u djece starosti od 7-9 godina i u osoba starijih od 20 godina. Plan pripravnosti za pandemijsku influencu zasniva se na povijesnim podacima o morbiditetu prethodnih epidemija influence u zemlji. Kratki pregled plana pripravnosti prikazan je korištenjem faza interpandemijskog i pandemijskog razdoblja u skladu s posljednjim definicijama Svjetske zdravstvene organizacije

2015/16 seasonal vaccine effectiveness against hospitalisation with influenza a(H1N1)pdm09 and B among elderly people in Europe: Results from the I-MOVE+ project

We conducted a multicentre test-negative caseâ\u80\u93control study in 27 hospitals of 11 European countries to measure 2015/16 influenza vaccine effectiveness (IVE) against hospitalised influenza A(H1N1)pdm09 and B among people aged â\u89¥ 65 years. Patients swabbed within 7 days after onset of symptoms compatible with severe acute respiratory infection were included. Information on demographics, vaccination and underlying conditions was collected. Using logistic regression, we measured IVE adjusted for potential confounders. We included 355 influenza A(H1N1)pdm09 cases, 110 influenza B cases, and 1,274 controls. Adjusted IVE against influenza A(H1N1)pdm09 was 42% (95% confidence interval (CI): 22 to 57). It was 59% (95% CI: 23 to 78), 48% (95% CI: 5 to 71), 43% (95% CI: 8 to 65) and 39% (95% CI: 7 to 60) in patients with diabetes mellitus, cancer, lung and heart disease, respectively. Adjusted IVE against influenza B was 52% (95% CI: 24 to 70). It was 62% (95% CI: 5 to 85), 60% (95% CI: 18 to 80) and 36% (95% CI: -23 to 67) in patients with diabetes mellitus, lung and heart disease, respectively. 2015/16 IVE estimates against hospitalised influenza in elderly people was moderate against influenza A(H1N1)pdm09 and B, including among those with diabetes mellitus, cancer, lung or heart diseases

Characteristics of influenza viruses isolated from humans in Croatia

Jedna od tri velike pandemije 20. stoljeća, zapravo najveća epidemija svih vremena tzv. "španjolska gripa" bila je uzrokovana virusom tipa A/H1N1/, a 1918. godine usmrtila je oko 50 milijuna ljudi. Zbog tog i sličnih događaja te pojava pandemija u prošlosti, Svjetska zdravstvena organizacija (SZO) ustrojila je niz od oko 110 Nacionalnih centara za influencu u različitim zemljama svijeta. U tim okvirima djeluje i Nacionalni centar za influencu Hrvatske. U ovom pregledu prikazane su osnovne karakteristike i obrasci pojavljivanja epidemija te karakteristike izolata virusa izdvojenih u Hrvatskoj u razdoblju od 1999. do 2005. godine.One of three major pandemics of the 20th century is the greatest epidemics of all times, the so called Spanish flu, caused by the virus of the type A/H1N1/, which in 1918 caused the death of around 50 million people. Because of this and similar past pandemics occurrences WHO has established a whole range of around 110 National influenza centers in different countries of the world. Within this framework the National influenza center for Croatia is also active. In this overview we will compare the basic characteristics and occurrence patterns of these epidemics as well as the characteristics of virus isolates extracted in Croatia in the period from 1999-2005

Characteristics of Circulating Influenza Viruses in Season 2010/11

U Hrvatskoj je evidentiran podjednak broj oboljelih od gripe u sezoni 2010/2011. (56.000, 28 preminulih), kao i u “pandemijskoj” 2009/2010. (58.000, 32 laboratorijski dokazano preminulih), dok je broj laboratorijski potvrđenih slučajeva nešto veći, tj. 1.756 u odnosu prema 1.561. Dok je vrhunac aktivnosti influence u Europi zamijećen tijekom 52. tjedna 2010, tj. krajem godine, u Hrvatskoj je bio kasnije u 5. tjednu 2011, tj. na početku mjeseca veljače. Laboratorijski je potvrđen 1.561 A/H1N1//California/7/2009. virus, 88 B/Brisbane/60/2008. virusa i jedan virus A/H3N2/Perth/16/2009.In Croatia, the number of flu cases in season 2010/2011 (56,000; 28 deceased) was almost equal to that in a pandemic season 2009/2010 (58,000; 32 laboratory proven deceased), while the number of laboratory-confirmed cases was slightly higher, i.e. 1,756 vs. 1,561. The peak of influenza activity in Europe was observed during the 52nd week of 2010, i.e. the end of the year. In Croatia, however, it was observed in the 5th week of 2011, i.e. in the beginning of February. There were 1561 A/H1N1//California/7/2009 laboratory-confirmed viruses, 88 B/Brisbane/60/2008 viruses and one A/H3N2/Perth/16/2009 virus